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Ultrasound elastography shows promise in predicting malignancy in thyroid nodules, according to Italian researchers. Dr. Paolo Vitti and colleagues at the University of Pisa note that such nodules are common, and the great majority are benign. Ultrasound elastography shows promise in predicting malignancy in thyroid nodules, according to Italian researchers.

In the August issue of The Journal of Clinical Endocrinology and Metabolism, Dr. Paolo Vitti and colleagues at the University of Pisa note that such nodules are common, and the great majority are benign. Fewer than five per cent are malignant.

Firmer nodules are associated with an increased risk of malignancy, they add, but this "is highly subjective and dependent on the experience of the examiner."

To evaluate the efficacy of ultrasound elastography in determining tissue stiffness and hence the risk of malignancy, the researchers employed the approach in 92 patients.

All underwent surgery because of compressive symptoms or suspicion of malignancy following fine needle aspiration (FNA) cytology. Thirty-one of the patients (34 per cent) had a final diagnosis of malignancy on histology.

Employing a five-point scale which rated 1 as the greatest elasticity and 5 as the least, 49 patients with benign lesions had a score of 1 or 2.

Only one of the 13 patients with a score of 3 had cancer, but this was true of all of the remaining 30 patients who had a score of 4 or 5.

Thus, say the investigators, scores of 4 or 5 were highly predictive of malignancy and gave a sensitivity of 97 per cent and a specificity of 100 per cent.

In 32 patients in whom FNA gave indeterminate results, conventional ultrasound was not predictive of malignancy. However, elastography gave a score of 4 or 5 in seven of the eight patients with malignancy, and a score of 3 or less in the remaining 25 patients with benign lesions.

The researchers call for further studies, but conclude that "ultrasound elastography seems to have great potential as a new tool for the diagnosis of thyroid cancer, especially in nodules with indeterminate cytology.