Journal of Medical Ultrasonics

, Volume 40, Issue 2, pp 169–174 | Cite as

The value of ultrasound elastography-guided fine-needle aspiration biopsy of thyroid nodules in reducing nondiagnostic results

  • Duzgun YildirimEmail author
  • Bengi Gurses
  • Berk Gurpinar
  • Baki Ekci
  • Bulent Colakoglu
  • Mutlu Sahin
  • Ahmet Kaur
Technical Note


Fine-needle aspiration biopsy (FNAB) is an important tool for diagnosing thyroid nodules; however, nondiagnostic results are a problem with FNAB. We evaluated the optimal targeting area of thyroid nodules for FNAB by using ultrasound elastography (USE) to reduce nondiagnostic results. Between December 2008 and November 2010, 96 consecutive prospective subjects scheduled to undergo FNAB were included in the study. Initially, the dominant nodule was evaluated with ultrasound, after which USE was performed. FNABs were performed from both the red (hard foci) and the green (soft foci) color-coded areas using the same technique according to the USE maps. The cellularity of all the specimens was evaluated cytopathologically. Nondiagnostic results from the red and green color-coded areas were compared by Chi-square test. In the red color-coded regions on USE images, the diagnostic rate was 76.0 % and the nondiagnostic rate was 24.0 %. In the green color-coded regions on USE images, the diagnostic rate was 53.1 % and the nondiagnostic rate was 46.9 %. Seven nodules were malignant and 89 were benign. Nondiagnostic results were significantly fewer in red color-coded regions (P = 0.0001). USE can help to enhance the cellularity of biopsy of thyroid nodules to reduce the nondiagnostic results if the red color-coded (less elastic or hard) areas are preferred.


Ultrasound elastography Thyroid nodule Fine-needle aspiration biopsy 


Conflict of interest



  1. 1.
    Rosen G. Beginnings of surgical biopsy. Am J Surg Pathol. 1977;1:361–4.CrossRefGoogle Scholar
  2. 2.
    Kwan SW, Bhargavan M, Kerlan RK Jr, Sunshine JH. Effect of advanced imaging technology on how biopsies are done and who does them. Radiology. 2010;256:751–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Moon WJ, Jung SL, Lee JH, et al. Ultrasonographic differentiation of benign and malignant thyroid nodules: a multicenter retrospective study. Radiology. 2008;247:762–70.PubMedCrossRefGoogle Scholar
  4. 4.
    Mittendorf EA, Tamarkin SW, McHenry CR. The results of ultrasound guided fine needle aspiration biopsy for evaluation of nodular thyroid disease. Surgery. 2002;132:648–54.PubMedCrossRefGoogle Scholar
  5. 5.
    Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Moon WJ, Baek JH, Jung SL, Korean Society of Thyroid Radiology (KSThR), Korean Radiological Society, et al. Ultrasonography and ultrasound-based management of thyroid nodules: consensus Statement and Recommendations. Korean J Radiol. 2011;12:1–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Ophir J, Alam SK, Garra B, et al. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H. 1999;213:203–33.PubMedGoogle Scholar
  8. 8.
    Gao L, Parker KJ, Lerner RM, Levinson SF. Imaging of the elastic properties of tissue: a review. Ultrasound Med Biol. 1996;22:959–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Sohn YM, Kim MJ, Kim EK, Kwak JY, Moon HJ, Kim SJ. Sonographic elastography combined with conventional sonography: how much is it helpful for diagnostic performance? J Ultrasound Med. 2009;28:413–20.PubMedGoogle Scholar
  10. 10.
    Bae U, Dighe M, Dubinsky T, et al. Ultrasound thyroid elastography using carotid artery pulsation: preliminary study. J Ultrasound Med. 2007;26:797–805.PubMedGoogle Scholar
  11. 11.
    Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T. Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology. 2006;17:251–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The papanicolaou Society of Cytopathology Task Force on Standards of Practice. Mod Pathol. 1996;9:710–5.Google Scholar
  13. 13.
    Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract. 2003;9:128–36.PubMedGoogle Scholar
  14. 14.
    Oertel YC, Miyahara-Felipe L, Mendoza MG, Yu K. Value of repeated fine needle aspirations of the thyroid: an analysis of over ten thousand FNAs. Thyroid. 2007;17:1061–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Degirmenci B, Haktanir A, Albayrak R, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol. 2007;62:798–803.PubMedCrossRefGoogle Scholar
  16. 16.
    Baloch ZW, Tam D, Langer J, Mandel S, LiVolsi VA, Gupta PK. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations. Diagn Cytopathol. 2000;23:425–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87:1941–6.PubMedCrossRefGoogle Scholar
  18. 18.
    O’Malley ME, Weir MM, Hahn PF, Misdraji J, Wood BJ, Mueller PR. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology. 2002;222:383–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of the Papanicolaou Society of Cytopathology for fine-needle aspiration procedure and reporting. Diagn Cytopathol. 1997;17:239–47.Google Scholar
  20. 20.
    Rausch P, Nowels K, Jeffrey RB Jr. Ultrasonographically guided thyroid biopsy: a review with emphasis on technique. J Ultrasound Med. 2001;20:79–85.PubMedGoogle Scholar
  21. 21.
    Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Rago T, Santini F, Scutari M, et al. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007;92:2917–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Shan B, Pelegri AA, Maleke C, et al. A mechanical model to compute elastic modulus of tissue for harmonic motion imaging. J Biomech. 2008;41:2150–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Kircheis G, Sagir A, Vogt C, et al. Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference. World J Gastroenterol. 2012;18:1077–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Yildirim D, Gurses B, Gurpinar B, et al. Nodule or pseudonodule? Differentiation in Hashimoto’s thyroiditis with sonoelastography. J Int Med Res. 2011;39(6):2360–9.Google Scholar
  26. 26.
    Hasegawa H, Kanai H. High-frame-rate echocardiography using diverging transmit beams and parallel receive beamforming. J Med Ultrasonics. 2011;38:129–40.Google Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2012

Authors and Affiliations

  • Duzgun Yildirim
    • 1
    • 8
    Email author
  • Bengi Gurses
    • 2
  • Berk Gurpinar
    • 3
  • Baki Ekci
    • 4
  • Bulent Colakoglu
    • 5
  • Mutlu Sahin
    • 6
  • Ahmet Kaur
    • 7
  1. 1.Department of RadiologyKasimpasa Military HospitalIstanbulTurkey
  2. 2.Department of RadiologyYeditepe University HospitalIstanbulTurkey
  3. 3.Department of OtolaryngologyKasimpasa Military HospitalIstanbulTurkey
  4. 4.Department of SurgeryYeditepe University HospitalIstanbulTurkey
  5. 5.Department of RadiologyVKV American HospitalIstanbulTurkey
  6. 6.Department of SurgeryIskenderun Military HospitalHatayTurkey
  7. 7.Laboratory of CytopathologyE-sitopatolojiIstanbulTurkey
  8. 8.Department of RadiologyIskenderun Military HospitalHatayTurkey

Personalised recommendations