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The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis

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Abstract

To appraise the literature for studies involving the use of elastography to diagnose thyroid nodule pathology. Two independent reviewers performed a systematic review of the English medical literature for studies involving elastography diagnosing thyroid nodule pathology. Data gleaned from this process was used in a meta-analysis to summarise the results. Thirty-eight studies were used in the meta-analysis totalling 5,942 thyroid nodules examined with elastography. The pooled results were sensitivity = 87.0 % (95 % confidence intervals (CI) = 86.2–87.9 %), specificity = 80.6 % (CI = 79.5–81.6 %), positive predictive value (PPV) = 48.9 % (CI = 47.6–50.2 %), negative predictive value (NPV) = 96.7 % (CI = 96.2–97.1 %), diagnostic accuracy = 81.7 % (CI = 80.7–82.7 %). Subgroup analysis of the data is also presented. Elastography has its limitations in the diagnosis of thyroid nodules; however, its high NPV is increasingly being used as an important investigation and may allow a reduction in the number of hemi-thyroidectomies with benign pathology. Subgroup analysis suggests that elastography techniques where compressive force is performed in a non-user-dependant method results in improved final results.

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References

  1. Tan GH, Gharib H (1997) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126(3):226–231

    Article  CAS  PubMed  Google Scholar 

  2. The British Thyroid Association and the Royal College of Physicians (2007) Guidelines for the management of thyroid cancer, 2nd edition

  3. Cáp J, Ryska A, Rehorková P, Hovorková E, Kerekes Z, Pohnetalová D (1999) Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf) 51(4):509–515

    Article  Google Scholar 

  4. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8(1):15–21

    Article  CAS  PubMed  Google Scholar 

  5. Ginat DT, Butani D, Giampoli EJ, Patel N, Dogra V (2010) Pearls and pitfalls of thyroid nodule sonography and fine-needle aspiration. Ultrasound Q 26(3):171–178

    Article  PubMed  Google Scholar 

  6. Tan WJ, Sanghvi K, Liau KH, Low CH (2010) An audit study of the sensitivity and specificity of ultrasound, fine needle aspiration cytology and frozen section in the evaluation of thyroid malignancies in a tertiary institution. Ann Acad Med Singap 39(5):359–362

    PubMed  Google Scholar 

  7. Sclabas GM, Staerkel GA, Shapiro SE, Fornage BD, Sherman SI, Vassillopoulou-Sellin R, Lee JE, Evans DB (2003) Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. Am J Surg 186(6):702–709

    Article  PubMed  Google Scholar 

  8. Barr RG (2012) Sonographic breast elastography: a primer. J Ultrasound Med 31(5):773–783

    PubMed  Google Scholar 

  9. Swiatkowska-Freund M, Preis K (2011) Elastography of the uterine cervix: implications for success of induction of labor. Ultrasound Obstet Gynecol 38(1):52–56

    Article  CAS  PubMed  Google Scholar 

  10. Aboumarzouk OM, Ogston S, Huang Z, Evans A, Melzer A, Stolzenberg JU, Nabi G (2012) Diagnostic accuracy of transrectalelastosonography (TRES) imaging for the diagnosis of prostate cancer: a systematic review and meta-analysis. BJU Int 110(10):1414–1423

    Article  PubMed  Google Scholar 

  11. Abraldes JG, Araujo IK, Turón F, Berzigotti A (2012) Diagnosing and monitoring cirrhosis: liver biopsy, hepatic venous pressure gradient and elastography. Gastroenterol Hepatol 35(7):488–495

    Article  PubMed  Google Scholar 

  12. Pei Q, Zou X, Zhang X, Chen M, Guo Y, Luo H (2012) Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: a meta-analysis. Pancreatology 12(5):402–408

    Article  PubMed  Google Scholar 

  13. Celebi I, Mahmutoglu AS (2013) Early results of real-time qualitative sonoelastography in the evaluation of parotid gland masses: a study with histopathological correlation. Acta Radiol 54(1):35–41

    Article  PubMed  Google Scholar 

  14. Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92(8):2917–2922

    Article  CAS  PubMed  Google Scholar 

  15. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, Zoppo A (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18(5):523–531

    Article  PubMed  Google Scholar 

  16. Ferrari FS, Megliola A, Scorzelli A, Guarino E, Pacini F (2008) Ultrasound examination using contrast agent and elastosonography in the evaluation of single thyroid nodules: preliminary results. J Ultrasound 11(2):47–54

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z (2009) Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med 28(7):861–867

    PubMed  Google Scholar 

  18. Luo S, Kim EH, Dighe M, Kim Y (2009) Screening of thyroid nodules by ultrasound elastography using diastolic strain variation. Conf Proc IEEE Eng Med Biol Soc 2009:4420–4423

    PubMed  Google Scholar 

  19. Dighe M, Kim J, Luo S, Kim Y (2010) Utility of the ultrasound elastographic systolic thyroid stiffness index in reducing fine-needle aspirations. J Ultrasound Med 29(4):565–574

    PubMed  Google Scholar 

  20. Friedrich-Rust M, Sperber A, Holzer K, Diener J, Grünwald F, Badenhoop K, Weber S, Kriener S, Herrmann E, Bechstein WO, Zeuzem S, Bojunga J (2010) Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 118(9):602–609

    Article  CAS  PubMed  Google Scholar 

  21. Gietka-Czernel M, Kochman M, Bujalska K, Stachlewska-Nasfeter E, Zgliczyński W (2010) Real-time ultrasound elastography—a new tool for diagnosing thyroid nodules. Endokrynol Pol 61(6):652–657

    PubMed  Google Scholar 

  22. Kagoya R, Monobe H, Tojima H (2010) Utility of elastography for differential diagnosis of benign and malignant thyroid nodules. Otolaryngol Head Neck Surg 143(2):230–234

    Article  PubMed  Google Scholar 

  23. Rago T, Scutari M, Santini F, Loiacono V, Piaggi P, Di Coscio G, Basolo F, Berti P, Pinchera A, Vitti P (2010) Real-time elastosonography: useful tool for refining the presurgical diagnosis in thyroid nodules with indeterminate or nondiagnostic cytology. J Clin Endocrinol Metab 95(12):5274–5280

    Article  CAS  PubMed  Google Scholar 

  24. Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, Oliver C (2010) Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab 95(12):5281–5288

    Article  CAS  PubMed  Google Scholar 

  25. Vorländer C, Wolff J, Saalabian S, Lienenlüke RH, Wahl RA (2010) Real-time ultrasound elastography–a noninvasive diagnostic procedure for evaluating dominant thyroid nodules. Langenbecks Arch Surg 395(7):865–871

    Article  PubMed  Google Scholar 

  26. Wang Y, Dan HJ, Dan HY, Li T, Hu B (2010) Differential diagnosis of small single solid thyroid nodules using real-time ultrasound elastography. J Int Med Res 38(2):466–472

    Article  CAS  PubMed  Google Scholar 

  27. Bhatia KS, Rasalkar DP, Lee YP, Wong KT, King AD, Yuen HY, Ahuja AT (2011) Cystic change in thyroid nodules: a confounding factor for real-time qualitative thyroid ultrasound elastography. Clin Radiol 66(9):799–807

    Article  CAS  PubMed  Google Scholar 

  28. Lippolis PV, Tognini S, Materazzi G, Polini A, Mancini R, Ambrosini CE, Dardano A, Basolo F, Seccia M, Miccoli P, Monzani F (2011) Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology? J Clin Endocrinol Metab 96(11):E1826–E1830

    Article  CAS  PubMed  Google Scholar 

  29. Luo S, Kim EH, Dighe M, Kim Y (2011) Thyroid nodule classification using ultrasound elastography via linear discriminant analysis. Ultrasonics 51(4):425–431

    Article  PubMed  Google Scholar 

  30. Merino S, Arrazola J, Cárdenas A, Mendoza M, De Miguel P, Fernández C, Ganado T (2011) Utility and interobserver agreement of ultrasound elastography in the detection of malignant thyroid nodules in clinical care. AJNR Am J Neuroradiol 32(11):2142–2148

    Article  CAS  PubMed  Google Scholar 

  31. Unlütürk U, Erdoğan MF, Demir O, Güllü S, Başkal N (2012) Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid 22(10):1031–1038

    Article  PubMed  Google Scholar 

  32. Bojunga J, Dauth N, Berner C, Meyer G, Holzer K, Voelkl L, Herrmann E, Schroeter H, Zeuzem S, Friedrich-Rust M (2012) Acoustic radiation force impulse imaging for differentiation of thyroid nodules. PLoS One 7(8):e42735

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Cappelli C, Pirola I, Gandossi E, Agosti B, Cimino E, Casella C, Formenti A, Castellano M (2012) Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings. J Ultrasound Med 31(11):1777–1782

    PubMed  Google Scholar 

  34. Cantisani V, D’Andrea V, Biancari F, Medvedyeva O, Di Segni M, Olive M, Patrizi G, Redler A, De Antoni EE, Masciangelo R, Frezzotti F, Ricci P (2012) Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur J Radiol 81(10):2678–2683

    Article  PubMed  Google Scholar 

  35. Cantisani V, Ulisse S, Guaitoli E, De Vito C, Caruso R, Mocini R, D’Andrea V, Ascoli V, Antonaci A, Catalano C, Nardi F, Redler A, Ricci P, De Antoni E, Sorrenti S (2012) Q-elastography in the presurgical diagnosis of thyroid nodules with indeterminate cytology. PLoS One 7(11):e50725

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Ciledag N, Arda K, Aribas BK, Aktas E, Köse SK (2012) The utility of ultrasound elastography and MicroPure imaging in the differentiation of benign and malignant thyroid nodules. AJR Am J Roentgenol 198(3):W244–W249

    Article  PubMed  Google Scholar 

  37. Friedrich-Rust M, Romenski O, Meyer G, Dauth N, Holzer K, Grünwald F, Kriener S, Herrmann E, Zeuzem S, Bojunga J (2012) Acoustic radiation force impulse-imaging for the evaluation of the thyroid gland: a limited patient feasibility study. Ultrasonics 52(1):69–74

    Article  PubMed  Google Scholar 

  38. Gu J, Du L, Bai M, Chen H, Jia X, Zhao J, Zhang X (2012) Preliminary study on the diagnostic value of acoustic radiation force impulse technology for differentiating between benign and malignant thyroid nodules. J Ultrasound Med 31(5):763–771

    PubMed  Google Scholar 

  39. Hong YR, Wu YL, Luo ZY, Wu NB, Liu XM (2012) Impact of nodular size on the predictive values of gray-scale, color-Doppler ultrasound, and sonoelastography for assessment of thyroid nodules. J Zhejiang Univ Sci B 13(9):707–716

    Article  PubMed Central  PubMed  Google Scholar 

  40. Mansor M, Okasha H, Esmat S, Hashem AM, Attia KA, El-din Hussein H (2012) Role of ultrasound elastography in prediction of malignancy in thyroid nodules. Endocr Res 37(2):67–77

    Article  PubMed  Google Scholar 

  41. Ragazzoni F, Deandrea M, Mormile A, Ramunni MJ, Garino F, Magliona G, Motta M, Torchio B, Garberoglio R, Limone P (2012) High diagnostic accuracy and interobserver reliability of real-time elastography in the evaluation of thyroid nodules. Ultrasound Med Biol 38(7):1154–1162

    Article  PubMed  Google Scholar 

  42. Slapa RZ, Piwowonski A, Jakubowski WS, Bierca J, Szopinski KT, Slowinska-Srzednicka J, Migda B, Mlosek RK (2012) Shear wave elastography may add a new dimension to ultrasound evaluation of thyroid nodules: case series with comparative evaluation. J Thyroid Res 2012:657147

    Article  PubMed Central  PubMed  Google Scholar 

  43. Shuzhen C (2012) Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol 81(8):1806–1811

    Article  PubMed  Google Scholar 

  44. Stoian D, Cornianuz M, Dobrescu A, Lazăr F (2012) Nodular thyroid cancer. Diagnostic value of real time elastography. Chirurgia (Bucur) 107(1):39–46

    CAS  Google Scholar 

  45. Veyrieres JB, Albarel F, Lombard JV, Berbis J, Sebag F, Oliver C, Petit P (2012) A threshold value in shear wave elastography to rule out malignant thyroid nodules: a reality? Eur J Radiol 81(12):3965–3972

    Article  PubMed  Google Scholar 

  46. Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C (2013) Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid 23(6):734–740

    Article  PubMed  Google Scholar 

  47. Dighe M, Luo S, Cuevas C, Kim Y (2013) Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules. Eur J Radiol 82(6):e274–e280

    Article  PubMed  Google Scholar 

  48. Mehrotra P, McQueen A, Kolla S, Johnson SJ, Richardson DL (2013) Does elastography reduce the need for thyroid FNAs? Clin Endocrinol (Oxf) 78(6):942–949

    Article  CAS  Google Scholar 

  49. Rivo-Vázquez A, Rodríguez-Lorenzo A, Rivo-Vázquez JE, Páramo-Fernández C, García-Lorenzo F, Pardellas-Rivera H, Casal-Núñez JE, Gil-Gil P (2013) The use of ultrasound elastography in the assessment of malignancy risk in thyroid nodules and multinodular goitres. Clin Endocrinol (Oxf) 79(6):887–891

    Article  Google Scholar 

  50. Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L (2013) Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 168(5):649–655

    Article  CAS  PubMed  Google Scholar 

  51. Shweel M, Mansour E (2013) Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules. Eur J Radiol 82(6):995–1001

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr Andrew McQueen, Consultant Head & Neck Radiologist, Freeman hospital, Newcastle, England for his invaluable advice and for providing the images of elastography scans. Ali Nikkar, ENT StR, Nottingham general hospital, England for procuring some of the publications for the meta-analysis.

Conflict of interest

There was no sponsorship or funding for this project, and no conflict of interest to declare.

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  1. James Cook University Hospital, Marton Rd, Middlesbrough, TS4 3BW, England, UK

    Vik Veer

  2. Glasgow Royal Infirmary, 84 Castle St, Glasgow, Glasgow City, G4 0SF, Scotland, UK

    Srikanth Puttagunta

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Correspondence to Vik Veer.

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Veer, V., Puttagunta, S. The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis. Eur Arch Otorhinolaryngol 272, 1845–1855 (2015). https://doi.org/10.1007/s00405-014-3155-7

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