Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules

Ki Young Kim M.D.; Jin Woo Cha M.D.; Seok Ho Choi M.D.; Chang Gyu Byun M.D.; Young Taek Koh M.D.; Dong Yup Seo M.D.

doi:10.16956/kjes.2010.10.4.229

Journal List > Korean J Endocr Surg > v.10(4) > 1060009

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M.D., M.D., M.D., M.D., M.D., and M.D.: Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules

Review Article

Korean J Endocrine Surg 2010;10(4):229-234.

Published online: 18 December 2010

DOI: https://doi.org/10.16956/kjes.2010.10.4.229

Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules

Ki Young Kim M.D., Jin Woo Cha M.D., Seok Ho Choi M.D., Chang Gyu Byun M.D., Ph.D., Young Taek Koh M.D., Dong Yup Seo M.D., Ph.D.

Department of Surgery, National Police Hospital, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness.

Methods:

From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1∼3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results.

Results:

Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and neg-ativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. Conclusion: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required. (Korean J Endocrine Surg 2010;10:229-234)

Keywords: Thyroid nodule, Ultrasound elastography, Fine needle aspiration cytology

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Table 1.

Ueno classification system accoridng to elastography ultrasound

Score	Definition
1	Entire area is evenly shaded green as is surrounding tissue.
2	Lesion area shows a mosaic pattern of green, blue, and red (soft).
3	Central part of the area is blue (stiff), and peripheral part is green.
4	Entire area is blue (stiff).
5	Entire area and its surrounding area are blue (stiff).

Provided by A. Tardivon based on the classification system developed by Dr. Ei Ueno.

Table 2.

Comparison of ultrasonography and histopathology

Ultrasonography	Histopahology
Ultrasonography	Benign (n=4)	Malignant (n=26)	Sensitivity	Specificity
Others∗	2	3	88.5%	50.0%
Suspicious malignant nodule	2	23

^∗ Others included probable benign and indeterminate nodules in ultrasonograhpy.

Table 3.

Comparison of elastography and histopathology

Elastography	Histopahology
Elastography	Benign (n=4)	Malignant (n=26)	Sensitivity	Specificity
1	2	0
2	2	9	100.0%	50.0%
3	0	17	65.4%	100.0%

Table 4.

Comparison of elastography and histopathology in 5 patients with indeterminate nodules on ultrasonography

Elastography	Histopathology		Sensitivity	Specificity
Elastography	Benign (n=2)	Malignant (n=3)	Sensitivity	Specificity
1	2	0	100.0%	100.0%
2∼3	0	3
1∼2	2	1	66.7%	100.0%
3	0	2

Table 5.

Comparison of ultrasonography, elastography, fine needle aspiration cytology, and histopathology

Ultrasonography	Elastography	FNAC			Histopathology
Ultrasonography	Elastography	Benign (n=2)	Indeterminate (n=6)	Malignant (n=22)	Benign (n=4)	Malignant (n=26)
Indeterminate nodule	1	1	1	0	2	0
	2	0	1	0	0	1
	3	0	1	1	0	2
Suspicious malignant nodule	1	0	0	0	0	0
	2	1	3	6	2	8
	3	0	0	15	0	15

Patients with Benign nodules according to ultrasonography have no histopathologic report.

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