title: Real-time ultrasound elastography--a noninvasive diagnostic procedure for evaluating dominant thyroid nodules.
abstract: OBJECTIVE
  Ultrasound elastography (USE) is a newly developed technique for the evaluation of tissue stiffness. It is known that malignancies often show a low-strain value. So far, only limited data for thyroid nodules is available.
  
  
  METHODS
  This study included 309 prospective evaluated patients with dominant, nontoxic thyroid nodules. All patients were referred to surgery. USE was performed preoperatively. Three measuring groups were formed: hard (< 0.15), intermediate (0.16-0.3), and soft (> 0.31). The measurements were correlated to the final histological findings.
  
  
  RESULTS
  The strain rated from 0.01 to 0.84 (mean 0.26 ± 0.13). A total of 50 thyroid malignancies (35 papillara carcinoma, 9 medullary carcinoma, and 6 follicular carcinoma) were observed. Patients (81) were within the hard group, 35 of them (43.2%) had thyroid cancer (TC) in final histology. Out of 132 patients in the intermediate group, 15 patients had TC (11.4%). All 96 patients from the soft group showed benign histological results (NPV 100%). Seventy percent of patients with TC were within the hard group (PPV 42%). These results were highly significant (p < 0.001). Coarse calcifications and cystic nodules were not connected with reliable measurements and therefore are not suitable for USE.
  
  
  CONCLUSIONS
  USE is a useful adjunctive tool in the workup of thyroid nodules. A low strain value needs surgical intervention, whereas a high strain value predicts a benign histology. It might substitute fine-needle aspiration cytology in the future.
authors.affiliation: Departement of Endocrine Surgery, Bürgerhospital Frankfurt am Main e.V., Nibelungenallee 37-41, 60318 Frankfurt, Germany. c.vorlaender@buergerhospital-ffm.de
authors.forename: Christian
authors.initials: C
authors.lastname: Vorländer
authors.forename: Jan
authors.initials: J
authors.lastname: Wolff
authors.forename: Said
authors.initials: S
authors.lastname: Saalabian
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lienenlüke
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wahl
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods