Comparative study between ultrasound elastography and fine-needle aspiration for the differentiation of thyroid masses

Abstract Background Thyroid nodules are frequent in clinical settings. Accurate differentiation between benign and malignant lesions is essential for management. Although fine-needle aspiration cytology (FNAC) is the diagnostic reference standard, it is invasive, operator-dependent, and may yield inconclusive results. Ultrasound elastography has emerged as an adjunctive imaging technique that may increase diagnostic confidence and minimize the need for invasive procedures. Objectives To assess the diagnostic performance of ultrasound elastography in preoperative thyroid nodules evaluation and correlate it with histopathological outcomes. Methods This prospective study was conducted on 200 patients complaining of thyroid nodules (40 males and 160 females, aged 30–69 years). All patients underwent a comprehensive neck examination and laboratory evaluation, including thyroid function tests, prothrombin time, and complete blood count. Imaging evaluation included conventional and Doppler ultrasound, shear wave elastography, strain elastography, ultrasound-guided fine-needle aspiration biopsy with histopathological evaluation. Final diagnosis was established by histopathology in surgically treated nodules and by benign cytology with stable clinical and ultrasound follow-up in Bethesda II nodules. Results Malignant nodules demonstrated significantly higher shear wave elastography (SWE) parameters than benign nodules ( P < 0.001). The elasticity ratio (ER) showed superior diagnostic performance, with a cut-off value of 2.5 achieving an AUC of 96.3% (95% CI: 93.3–99.4), with 90.9 % sensitivity and 89.4% specificity. The strain index (SI) showed optimal diagnostic performance at a threshold value of 1.3 achieving an AUC 97%; (95% CI: 93.2–100), with a diagnostic sensitivity of 97% and specificity of 88%. Conclusions Ultrasound elastography demonstrates excellent diagnostic capability in distinguishing malignant from benign thyroid nodules. Its integration with conventional ultrasound may improve risk stratification and help reduce unnecessary FNAC or surgical procedures, particularly in low-to-intermediate risk (TI-RADS 3 and 4) nodules.