title: Elastography-targeted Thyroid Nodule Aspiration: A Novel Approach.
abstract: OBJECTIVE
  Since 2009, the rate of nondiagnostic (ND) thyroid nodule fine-needle aspiration (FNA) has ranged from 2% to 20%. A ND result can cause further patient morbidity secondary to repeated procedures and delay in diagnosis. The use of real-time strain elastography (RTE) in determining nodule malignant risk has gained considerable focus recently. A less studied area where RTE may prove beneficial is its role in targeting areas for FNA. Our hypothesis is that FNA performed in concurrence with RTE will show a decreased rate of ND results leading to fewer repeated FNA.
  
  
  METHODS
  The Institutional Review Board approval was obtained. A retrospective review of all thyroid nodule FNA from January 1, 2011, to January 1, 2014, was performed with review of nodule size, presence of microcalcifications, vascularity, solid components, patient age, and gender. Cases were separated based if RTE was done before FNA or not. Pathology reports were reviewed to assess for specimen adequacy. Statistical comparison was performed using SAS analysis software.
  
  
  RESULTS
  A total of 221 specimens were reviewed, with RTE performed on 140 cases (63.4%). Both groups were similar in demographics and previously described nodule characteristics. The ND rate when RTE was not performed was 16% (13/68) compared to 10% when RTE was performed (14/126). The difference was not found to be statistically significant, P = 0.205.
  
  
  CONCLUSIONS
  The presence of an elastogram failed to demonstrate a significant decrease in ND FNA rates although these results may be secondary to study design. Further evaluation with prospective trials using larger sample size may ultimately detect increased accuracy of RTE-targeted FNA.
authors.affiliation: Department of Radiology, Staten Island University Hospital, Staten Island, New York, NY, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Landau
authors.affiliation: Department of Radiology, Staten Island University Hospital, Staten Island, New York, NY, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Del Re
authors.affiliation: Touro College of Osteopathic Medicine, New York, NY, USA.
authors.forename: Bina
authors.initials: B
authors.lastname: Kviatkovsky
authors.affiliation: Yeshiva University, New York, NY, USA.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Rothstein
authors.affiliation: Department of Radiology, Staten Island University Hospital, Staten Island, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Scheiner
authors.affiliation: Department of Radiology, Staten Island University Hospital, Staten Island, New York, NY, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Lin
keywords: Elastography; fine-needle aspiration; nondiagnostic; thyroid nodule; ultrasound