title: Real-time ultrasound elastography for differentiation of benign and malignant thyroid nodules: a meta-analysis.
abstract: OBJECTIVE
  The clinical challenge of managing thyroid nodules nowadays is to diagnose the minority of malignant disease. Real-time ultrasound elastography, which can measure tissue elasticity, is used as a complement to conventional sonography for improving the diagnosis of thyroid tumors. There are 2 common criteria for evaluating an elastogram: the elasticity score and strain ratio. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ultrasound elastography in differentiating benign and malignant thyroid nodules for elasticity score and strain ratio assessment.
  
  
  METHODS
  The MEDLINE, EMBASE, PubMed, and Cochrane Library databases up to January 31, 2013, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random-effects model. The extent and sources of heterogeneity were explored.
  
  
  RESULTS
  A total of 5481 nodules in 4468 patients for elasticity score studies and 1063 nodules in 983 patients for strain ratio studies were analyzed. The overall mean sensitivity and specificity of ultrasound elastography for differentiation of thyroid nodules were 0.79 (95% confidence interval [CI], 0.77-0.81) and 0.77 (95% CI, 0.76-0.79) for elasticity score assessment and 0.85 (95% CI, 0.81-0.89) and 0.80 (95% CI, 0.77-0.83) for strain ratio assessment, respectively. The areas under the curve for the elasticity score and strain ratio were 0.8941 and 0.9285.
  
  
  CONCLUSIONS
  These results confirmed those obtained in the previous meta-analysis. Ultrasound elastography has high sensitivity and specificity for identification of thyroid nodules. It is a promising tool for reducing unnecessary fine-needle-aspiration biopsy.
authors.affiliation: Department of Ultrasound, First Affiliated Hospital of China Medical University, 155 Nanjing N St, Heping District, 110001 Shenyang, Liaoning, China. wxmlmt@yahoo.com.cn.
authors.forename: Jiasi
authors.initials: J
authors.lastname: Sun
authors.forename: Jingyu
authors.initials: J
authors.lastname: Cai
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D019245:Compressive Strength; D003199:Computer Systems; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013718:Tensile Strength; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*
keywords: elasticity score; elastography; general ultrasound; meta-analysis; strain ratio; thyroid nodules