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Year : 2018  |  Volume : 22  |  Issue : 5  |  Page : 589-596

Ultrasound elastography is a useful adjunct to conventional ultrasonography and needle aspiration in preoperative prediction of malignancy in thyroid nodules: A Northern India perspective

1 Department of Radiology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India
2 Department of Endocrinology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India
3 Department of Endocrine Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India
4 Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
5 Department of Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India
6 Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India

Correspondence Address:
Deep Dutta
Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospitals, New Delhi - 110 085
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijem.IJEM_634_17

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Introduction: Data on ultrasound elastography (USE) are scant from India. This study aimed to compare the sensitivity and specificity of USE with thyroid ultrasonography (USG) and fine-needle aspiration (FNA) as preoperative predictor of malignancy, using postoperative histopathology as gold standard. Materials and Methods: Consecutive patients with thyroid swelling/goiter underwent thyroid USG followed by USE. Patients with pure cystic nodules or eggshell calcification were excluded. Patients with nodules >10 mm with one or more high-risk USG features underwent FNA. Patients with no USG high-risk features, benign score on USE, and benign FNA were conservatively followed. All other patients underwent thyroidectomy. Results: 246 consecutive patients underwent USG. Data from 97 patients (117 nodules) were analyzed. Median age of patients was 43 years with 85.4% females. All patients with USE score-1 had benign USG and FNA characteristics. Of 86 nodules having USE score-2, 18.6% nodules were hypoechoic and 16.28% had microcalcification. Hypoechogenicity and microcalcifications were observed in 66.67% nodules with USE score-3. All nodules with USE score-4 and 5 were hypoechoic and had microcalcifications. Histopathology was benign in 84 and malignant in 33 patients. Occurrence of malignancy in USE scores 1–5 was 0, 4.65, 100, 90.5, and 100%, respectively. All eight nodules with diagnosis of follicular adenoma had preoperative USE score-2. The sensitivity of preoperative USG, USE, and FNA in picking up malignancy was 66.67, 87.88, and 69.70%, respectively. Specificity of USG, USE, and FNA in detecting thyroid malignancy was 88.10, 100, and 97.6%, respectively. False positivity rates for USG, USE, and FNA in diagnosing thyroid malignancy was 11.9, 0, and 2.4%, respectively. The overall diagnostic accuracy of USG, USE, and FNA cytology in this study was 82.05, 96.58, and 89.74%, respectively. Conclusion: USE may be better than USG for preoperative detection of malignancy in thyroid nodules.

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