title: Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings.
abstract: OBJECTIVE
  The aim of this study was to evaluate the predictive value of sonography and sonographic elastography in thyroid nodules with nondiagnostic cytologic findings.
  
  
  METHODS
  The study included 101 patients (74 female, mean age ± SD, 55 ± 11 years [range, 27-70 years]; and 27 male, mean age, 62 ± 9 years [range, 42-72 years]) who had at least 1 nodule with nondiagnostic cytologic findings at two different fine-needle aspiration cytologic evaluations and with an indication for hemi or total thyroidectomy for clinical suspicion of malignancy, nodule size, or the occurrence of a coexisting nodule with cytologic findings suspicious for malignancy. All of the patients underwent sonography and elastography 2 months after the second fine-needle aspiration and before surgery. The elastogram was matched with an elasticity color scale and classified as follows: score 1, nodules with high elasticity (soft); score 2, nodules with indeterminate elasticity; and score 3, nodules with low elasticity (hard).
  
  
  RESULTS
  A total of 135 nodules (93.7%) were hyperplastic; 15 (9.4%) were papillary carcinomas; and 9 (6.3%) were follicular adenomas. The association of scores 2 and 3 identified 12 of 15 thyroid cancers (sensitivity, 80.0%; specificity, 93.7%; positive predictive value, 57.1%; negative predictive value, 97.8%; and accuracy, 92.4%), whereas the association of conventional sonographic features plus scores 2 and 3 identified all of the cancers (specificity, 70.8%; positive predictive value, 26.3%; negative predictive value, 100%; and accuracy, 73.6%).
  
  
  CONCLUSIONS
  Our data suggest that elastography could be a promising tool in the management of nodules that are nondiagnostic at cytologic evaluation, reducing unnecessary surgery.
authors.affiliation: Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, c/o 1 Medicina Spedali Civili di Brescia, 1 Piazzale Spedali Civili, 25100 Brescia, Italy. cappelli@med.unibs.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Cappelli
authors.forename: Ilenia
authors.initials: I
authors.lastname: Pirola
authors.forename: Elena
authors.initials: E
authors.lastname: Gandossi
authors.forename: Barbara
authors.initials: B
authors.lastname: Agosti
authors.forename: Elena
authors.initials: E
authors.lastname: Cimino
authors.forename: Claudio
authors.initials: C
authors.lastname: Casella
authors.forename: Annamaria
authors.initials: A
authors.lastname: Formenti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Castellano
mesh_terms: D000328:Adult; D000368:Aged; D003199:Computer Systems; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology*