title: Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology?
abstract: BACKGROUND
  Although fine-needle aspiration cytology remains the mainstay of the preoperative workup of thyroid nodules, those with follicular proliferation still represent a diagnostic challenge. Real-time elastography (RTE) estimates the stiffness/elasticity of lesions and is regarded as a promising technique for the presurgical selection of thyroid nodules (including those with indeterminate cytology).
  
  
  OBJECTIVE
  Our aim was to verify the potential role of RTE in the presurgical diagnosis of cancer in a large cohort of consecutive patients with follicular thyroid nodules.
  
  
  METHODS
  One hundred two patients were submitted to conventional ultrasonography and RTE evaluation before being operated on for thyroid nodule with indeterminate cytology (54% single nodules). Tissue stiffness on RTE was scored from 1 (greatest elasticity) to 4 (no elasticity).
  
  
  RESULTS
  At conventional ultrasonography examination, the nodules (median diameter 2.2 cm) were solid (cystic areas < 10%); microcalcifications were detected in 56% of them and a hypoechoic pattern in 64%. Elasticity was high in eight cases only (score 1-2) although low in 94 (score 3-4). Cancer was diagnosed in 36 nodules (35%), being associated with microcalcifications (P < 0.0001) and inversely related to nodule diameter (P < 0.01). Malignancy was detected in 50% of the nodules with RTE score 1-2 and in 34% of those with score 3-4. Therefore, either the positive (34%) or the negative predictive value (50%) was clinically negligible.
  
  
  CONCLUSIONS
  The current study does not confirm the recently reported usefulness of RTE in presurgical selection of nodules with indeterminate cytology and suggest the need for quantitative analytical assessment of nodule stiffness to improve RTE efficacy.
authors.affiliation: Department of Surgery, University of Pisa, 56126 Pisa, Italy.
authors.forename: P V
authors.initials: PV
authors.lastname: Lippolis
authors.forename: S
authors.initials: S
authors.lastname: Tognini
authors.forename: G
authors.initials: G
authors.lastname: Materazzi
authors.forename: A
authors.initials: A
authors.lastname: Polini
authors.forename: R
authors.initials: R
authors.lastname: Mancini
authors.forename: C E
authors.initials: CE
authors.lastname: Ambrosini
authors.forename: A
authors.initials: A
authors.lastname: Dardano
authors.forename: F
authors.initials: F
authors.lastname: Basolo
authors.forename: M
authors.initials: M
authors.lastname: Seccia
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
authors.forename: F
authors.initials: F
authors.lastname: Monzani
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery