Real‐time Ultrasound Elastography in the Differential Diagnosis of Benign and Malignant Thyroid Nodules

Objective. The purpose of this study was to evaluate the diagnostic utility of real‐time ultrasound elastography in differentiating benign from malignant thyroid nodules. Methods. A total of 90 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. One hundred forty‐five nodules in these patients were examined by B‐mode ultrasound, color Doppler ultrasound, and ultrasound elastography. The final diagnosis was obtained from histologic findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 6 (high stiffness over the entire nodule and surrounding tissue). Results. On real‐time ultrasound elastography, 86 of 96 benign nodules (90%) had a score of 1 to 3, whereas 43 of 49 malignant nodules (88%) had a score of 4 to 6 (P <.001), with sensitivity of 88%, specificity of 90%, a positive predictive value of 81%, and a negative predictive value of 93%. The predictivity of ultrasound elastographic measurement was independent of the nodule size. High sensitivity (88%) and specificity (93%) were also observed in 68 nodules that had a greatest diameter of 1 cm or less. Conclusions. Real‐time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer.

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