Diagnostic Value Sonoelastography in Differential Diagnosis of Thyroid Nodules

The aim of the investigation was to assess the reliability of main sonoelastographic diagnostic criteria of thyroid cancer and determine sonoelastography efficiency in pre-operative diagnostics of thyroid nodules based on a complex of radiological, cytologic and histologic methods.

Materials and Methods. The study involved 372 patients with thyroid nodules, among them there were 87 (13%) male and 285 (87%) female patients; mean age being 44.90±0.30 years. All the patients underwent standard diagnostic procedures: an endocrinal examination, a hormone laboratory test, an ultrasound investigation using color flow Doppler supplemented by sonoelastography, as well as fine-needle aspiration biopsy of nodules followed by cytologic analysis.

Results. Diagnosis of “adenoma or cancer” in 80 patients (95%) made on the basis of sonoelastographic and cytologic findings was confirmed by histologic examination of surgical materials. Sonoelastography sensitivity in thyroid cancer detection is 95.3%, specificity — 98.2%, diagnostic accuracy — 96%.

Conclusion. Qualitative elastographic characteristics of nodules (blue staining) and quantitative value of strain ratio, which equals to over 4, are high-specific in pre-operative thyroid cancer diagnosis. Sonoelastography application improves the diagnostic accuracy of a pre-operative diagnostic complex of thyroid nodule facilitating the management of patients with thyroid pathology.

1. Prakticheskoe rukovodstvo po ul’trazvukovoy diagnostike. Obshchaya ul’trazvukovaya diagnostika [Practice guidelines on ultrasound diagnostics. General ultrasound diagnosis]. Pod red. Mit’kova V.V. [Mit’kov V.V. (editor)]. Moscow: Vidar; 2005; 698 p.
2. Giordano D., Valcavi R., Thompson G.B., Pedroni C., Renna L., Gradoni P., Barbieri V. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 2012; 22(9): 911–917, http://dx.doi.org/10.1089/thy.2012.0011. Epub 2012 Jul 24.
3. Park C.S., Kim S.H., Jung S.L., Kang B.J., Kim J.Y., Choi J.J., Sung M.S., Yim H.W., Jeong S.H. Observer variability in the sonographic evaluation of thyroid nodules. J Clin Ultrasound 2010; 38(6): 287–293, http://dx.doi.org/10.1002/jcu.20689.
4. Yu-rong Hong, Yu-lian Wu, Zhi-yan Luo, Ning-bo Wu, Xue-ming Liu. Impact of nodular size on the predictive values of gray-scole, color–Doppler ultrasound end sonoelastography for assessment of thyroid nodules. J Zhejiang Univ Sci B 2012 Sept; 13(9): 707–716, http://dx.doi.org/10.1631/jzus.B1100342.
5. Khokhlova E.A., Zubarev A.V., Rozhkova N.I. Vozmozhnosti sonoelastografii v utochnyayushchey diagnostike zabolevaniy molochnykh zhelez [Sonoelastography capabilities in specifying diagnostics of breast diseases]. Kremlevskaya meditsina. Klinicheskiy vestnik — Kremlin Medicine. Clinical Vestnik 2009; 3: 41–48.
6. Korzhevskiy D.E., Gilyarov A.V. Osnovy gistologicheskoy tekhniki [Basics of histological techniques]. Saint Petersburg: SpetsLit., 2010.
7. Samir A.E., Vij A., Seale M.K., Desai G., Halpern E., Faquin W.C., Parangi S., Hahn P.F., Daniels G.H. Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 2012; 22(5): 461–467, http://dx.doi.org/10.1089/thy.2011.0061.
8. The Bethesda system for reporting thyroid cytopathology. Definitions. Criteria and explanatory notes. Syed Z. Ali, Edmund S. Cibas (Eds.). Springer; 2010.
9. Abrosimov A.Yu., Kazantseva I.A., Lushnikov E.F. Morfologicheskaya diagnostika zabolevaniy shchitovidnoy zhelezy [Morphological diagnosis of thyroid diseases]. Moscow: OOO «MK»; 2012.

Bederina Е.L., Orlinskaya N.Y., Konovalov V.А., Zubeev P.S. Diagnostic Value Sonoelastography in Differential Diagnosis of Thyroid Nodules. Sovremennye tehnologii v medicine 2014; 6(1): 43