Photo Credit: Dr Microbe

The following is a summary of “Additive value of real-time elastography to thyroid ultrasound in detecting papillary carcinoma in nodules over 20 mm in diameter,” published in the April 2025 issue of Endocrine by Angelopoulos et al. 

Ultrasonography (US) was the most accurate and cost-effective imaging method for identifying thyroid nodules, and the challenge of determining which nodules to sample with fine-needle aspiration (FNA) cytology led to the introduction of the Thyroid Imaging Reporting and Data Systems (TIRADS), while real-time elastography (RTE), along with strain ratio measurements, offered a way to assess nodule stiffness and potentially predict malignancy.  

Researchers conducted a retrospective study to evaluate the effectiveness of RTE and strain ratio, in combination with the TIRADS, for differentiating benign from malignant thyroid nodules.  

They included individuals from a pool of 1,094 people with thyroid nodules who were referred for thyroid US at a university hospital. Only those with nodules measuring at least 20 mm in diameter were selected. Each nodule was classified using both the European [EU-TIRADS] and American College of Radiology [ACR-TIRADS] systems, with scores ranging from 2 to 5 and RTE was used to assess stiffness, and strain ratio values were recorded. Final diagnoses were determined using either post-thyroidectomy histopathology or ultrasound-guided FNA, interpreted according to the Bethesda classification system.  

The results showed that 267 individuals (mean age 60.3 ± 14.3 years; 46 males, 221 females) presented with 308 thyroid nodules assigned to EU-TIRADS categories 3, 4, and 5. Among these, 22 nodules were malignant, and 286 were benign. The elastography strain ratio demonstrated strong diagnostic accuracy for thyroid cancer (P < 0.001) with an optimal threshold of >0.84, yielding a sensitivity of 90.9% and specificity of 73.4%. In the subset of 168 nodules classified as [EU-TIRADS 3], this threshold showed 100% sensitivity and 75.1% specificity for identifying malignancy.  

Investigators concluded that integrating TIRADS with data from RTE reduced the number of unnecessary FNAs and surgeries in patients with thyroid nodular disease. 

Source: link.springer.com/article/10.1007/s12020-025-04248-1