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Elastography: Applications and Limitations of a New Technology

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Advanced Thyroid and Parathyroid Ultrasound

Abstract

Thyroid nodules are extremely common, reported in up to a third of adults (Hegedus et al., Endocr Rev, 24(1):102–132, 2003). The majority of thyroid nodules are benign; however, 5–15 % are malignant (Tumbridge et al., Clin Endocrinol, 7:481–493, 1997). Neck ultrasound with Doppler is considered a first-line study in the evaluation of the thyroid gland and has shown to be accurate in estimating malignancy risk and for selection of which nodules require biopsy (Frates et al., Radiology, 237(3):794–800, 2005). Features associated with malignancy include microcalcifications, increased vascular flow, and irregular borders; however, no one feature or combination has been shown to reliably identify malignant nodules (Haugen et al., Thyroid, 26(1):1–133, 2016). To further assess the risk of malignancy, nodules are typically subjected to fine-needle aspiration biopsy (FNAB). FNAB has excellent sensitivity and specificity, but has inherent limitations as 15–30 % of nodules are categorized as indeterminate (Dhyani et al., Am J Roentgenol, 201(6):1335–1339, 2013). Traditionally, the majority of patients with indeterminate cytology are referred for diagnostic thyroid lobectomy.

Ultrasound (US)-based elastography is a technique that evaluates the firmness or stiffness of tissues (Russ et al., Eur J Endocrinol, 168(5):649–655, 2013). On physical exam, a hard or firm growth or nodule is typically associated with malignancy. Elastography has been used in other organs, such as the breast and prostate, to estimate malignancy risk, and US-based elastography for the evaluation of thyroid nodules has been introduced and studied as a complimentary test to the limitations of conventional ultrasound and FNAB (Shuzhen, Eur J Radiol, 81(8):1806–1811, 2012). The purpose of this chapter is to review the ultrasound elastography techniques currently available for thyroid nodule evaluation and discuss the limitations of this relatively new technology in characterizing thyroid nodules and estimating the risk of malignancy.

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Author information

Authors and Affiliations

  1. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    Manish Dhyani M.D. & Anthony E. Samir

  2. Department of Ultrasound, Chinese PLA General Hospital, The Southern Building, 28th Fuxing Road, Haidian District, Beijing, 100853, China

    Changtian Li M.D., Ph.D.

  3. Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey 7B, 55 Fruit Street, Boston, MA, 02114, USA

    Antonia E. Stephen M.D.

Authors
  1. Manish Dhyani M.D.
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  2. Changtian Li M.D., Ph.D.
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  3. Anthony E. Samir
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  4. Antonia E. Stephen M.D.
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Corresponding author

Correspondence to Antonia E. Stephen M.D. .

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Editors and Affiliations

  1. Department of Surgery and the Endocrinology & Metabolism Institute, University of Arizona College of Medicine - Phoenix, Banner - University Medical Center Phoenix, Phoenix, Arizona, USA

    Mira Milas

  2. Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Susan J. Mandel

  3. Department of Radiology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Jill E. Langer

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Dhyani, M., Li, C., Samir, A.E., Stephen, A.E. (2017). Elastography: Applications and Limitations of a New Technology. In: Milas, M., Mandel, S.J., Langer, J.E. (eds) Advanced Thyroid and Parathyroid Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-44100-9_8

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  • DOI: https://doi.org/10.1007/978-3-319-44100-9_8

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