Diagnostic Accuracy of Fine Needle Aspiration Cytology and Shear Wave Elastography in Diagnosis of Malignant Thyroid Nodules Taking Post-Operative Histopathology as Gold Standard

Sadia Zafar; Abubakar Khalid; Khush Bakht; Saadoon Mazhar

doi:10.70749/ijbr.v3i5.1471

Authors

Sadia Zafar Department of Gynaecology & Obstetrics, Lahore General Hospital Lahore, Pakistan.
Abubakar Khalid Rashid Latif Medical College, Lahore, Pakistan.
Khush Bakht Fauji Foundation Hospital, Lahore Cantt, Pakistan.
Saadoon Mazhar Department of Medicine, Lahore General Hospital, Lahore, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1471

Keywords:

Thyroid nodules, Fine needle aspiration cytology, Shear wave elastography, Diagnostic accuracy, Thyroid cancer, Histopathology

Abstract

Background: Precise diagnosis of malignant thyroid nodule is a very important aspect in directing the clinical approach, and in preventing unnecessary surgeries. This had been the standard diagnostic modality for a long time; Fine needle aspiration cytology (FNAC). yet, its loopholes in indeterminate cytological categories have generated an interest in non-invasive such as shear wave elastography (SWE) which measures tissue stiffness. Aim: To compare the diagnostic accuracy of FNAC and SWE for diagnosis of the malignant thyroid nodules, compared to a histopathology reference standard. Methods: This cross-sectional study was undertaken at the Department of Radiology, Lahore General Hospital in six months. 170 patients aged 20–60 years with ultrasound suspicious thyroid nodules were examined. Each patient received SWE performed by an experienced radiologist, FNAC and later histopathological confirmation. Diagnostic performance was estimated within the boundaries of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Analysis of Data was performed in SPSS version 22.0. Results: SWE showed superior diagnostic performance with a specificity of 98.6%, sensitivity of 69.2%, PPV of 90.0%, NPV of 94.8%, and an overall diagnostic accuracy of 94.1%. SWE score 4 was highly predictive of malignancy, while score 1 reliably excluded it. In contrast, FNAC achieved 80% sensitivity and 85% specificity when Bethesda categories B3–B6 were considered malignant. Diagnostic performance of FNAC improved to 100% sensitivity and 90% specificity when only B5–B6 were classified as malignant. Histopathology confirmed that solitary nodules were more often malignant than multiple nodules. Conclusion: SWE demonstrated better overall diagnostic accuracy and non-invasiveness compared to FNAC, particularly in stratifying benign versus malignant nodules. While FNAC remains essential for cytological confirmation, SWE offers substantial advantages in specificity and can effectively guide biopsy decisions, especially in clearly benign or highly suspicious cases.

Downloads

Download data is not yet available.

References

Abdallah, A. A., Mahmoud, M. Z., Hassouna, M. S., Elkaffas, K., Eltelety, A. M., & Zamzam, S. M. (2024). The added value of shear wave elastography when combined to conventional ultrasonography and fine-needle aspiration cytology in detection of malignant thyroid nodule. The Egyptian Journal of Otolaryngology, 40(1), 89.

https://doi.org/10.1186/s43163-024-00652-y

Aghaghazvini, L., Maheronnaghsh, R., Soltani, A., Rouzrokh, P., & Chavoshi, M. (2020). Diagnostic value of shear wave sonoelastography in differentiation of benign from malignant thyroid nodules. European Journal of Radiology, 126, 108926.

https://doi.org/10.1016/j.ejrad.2020.108926

Baz, A. A. A., Mohamed, A. H. I., El-Esawy, Y. F. G., & El-kaffas, K. H. (2021). Conventional ultrasound, color Doppler, TI-RADS, and shear wave elastography for thyroid nodule differentiation: a study of efficacy compared with the histopathology results. Egyptian Journal of Radiology and Nuclear Medicine, 52, 1–14.

https://doi.org/10.1186/s43055-021-00474-5

Borysewicz-Sańczyk, H., Bossowski, F., Anikiej, K., Sawicka, B., Michalak, J., Dzięcioł, J., & Bossowski, A. (2024). Application of shear wave elastography in the management of thyroid nodules in children and adolescents: our experience and a review of the literature. Frontiers in Endocrinology, 15, 1486285.

https://doi.org/10.1530/endoabs.101.ps1-09-04

Chambara, N., Lo, X., Chow, T. C. M., Lai, C. M. S., Liu, S. Y. W., & Ying, M. (2022). Combined shear wave elastography and EU TIRADS in differentiating Malignant and benign thyroid nodules. Cancers, 14(22), 5521.

https://doi.org/10.3390/cancers14225521

Chen, Y., Dong, B., Jiang, Z., Cai, Q., Huang, L., & Huang, H. (2022). SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules: A meta-analysis. Journal of Endocrinological Investigation, 45(7), 1327–1339.

https://doi.org/10.1007/s40618-022-01765-y

Filho, R. H. C., Pereira, F. L., & Iared, W. (2020). Diagnostic accuracy evaluation of two‐dimensional shear wave elastography in the differentiation between benign and malignant thyroid nodules: systematic review and meta‐analysis. Journal of Ultrasound in Medicine, 39(9), 1729–1741.

https://doi.org/10.1002/jum.15271

Hazem, M., Zakaria, O. M., Daoud, M. Y. I., Al Jabr, I. K., AlYahya, A. A., Hassanein, A. G., Alabdulsalam, A. A., AlAlwan, M. Q., & Hasan, N. M. A. (2021). Accuracy of shear wave elastography in characterization of thyroid nodules in children and adolescents. Insights into Imaging, 12, 1–10.

https://doi.org/10.1186/s13244-021-01074-7

Jesrani, A., Hameed, M., Ahmed, N., Devi, P., & Baseer, A. (2021). Diagnostic Accuracy of Elastography in Differentiating Benign from Malignant Thyroid Nodules Taking Fine Needle Aspiration Cytology as Gold Standard. Journal of Bahria University Medical and Dental College, 11(2), 70–75.

https://doi.org/10.51985/olbl1894

Mahmoud, S. A. E., Enaba, M. E., Shareef, M. M., Hafez, Y. M., & Abbas, I. (2024). Comparison the accuracy of thyroid sono-elastography vs. ultrasound-guided fine needle aspiration cytology with thyroid malignancy diagnosis histopathology. Endocrine Regulations, 58(2), 129–137.

https://doi.org/10.2478/enr-2024-0014

Mena, G., Montalvo, A., Ubidia, M., Olmedo, J., Guerrero, A., & Leon-Rojas, J. E. (2023). Elastography of the thyroid nodule, cut-off points between benign and malignant lesions for strain, 2D shear wave real time and point shear wave: a correlation with pathology, ACR TIRADS and Alpha Score. Frontiers in Endocrinology, 14, 1182557.

https://doi.org/10.3389/fendo.2023.1182557

Naleini, F., Pirani, A., Naseri, R., Karami, Z., Shahpasandi, M. H. R., Kamangar, P. B., & Bakhtiari, N. (2022). Comparing shear wave elastography and fine needle aspiration in the diagnosis of solid thyroid nodules. European Journal of Translational Myology, 32(4), 10635.

https://doi.org/10.4081/ejtm.2022.10635

Nattabi, H. A., Sharif, N. M., Yahya, N., Ahmad, R., Mohamad, M., Zaki, F. M., & Yusoff, A. N. (2022). Is diagnostic performance of quantitative 2D-shear wave elastography optimal for clinical classification of benign and malignant thyroid nodules?: A systematic review and meta-analysis. Academic Radiology, 29, S114–S121.

https://doi.org/10.1016/j.acra.2017.09.002

Qiu, Y., Xing, Z., Liu, J., Peng, Y., Zhu, J., & Su, A. (2020). Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis. European Radiology, 30, 6624–6634.

https://doi.org/10.1007/s00330-020-07023-0

Qiu, Y., Xing, Z., Yang, Q., Luo, Y., & Ma, B. (2023). Diagnostic performance of shear wave elastography in thyroid nodules with indeterminate cytology: A systematic review and meta-analysis. Heliyon, 9(10).

https://doi.org/10.1016/j.heliyon.2023.e20654

Rajabzadeh, F., Hassannejad, E., Akhlaghipour, I., Imen, M. J., Babazadeh Baghan, A., Goshayeshi, L., Taghavi, S. M., Vojouhi, S., Payandeh, A., & Moodi Ghalibaf, A. (2023). Differentiating benign and malignant thyroid nodules: A cross‐sectional study on the comparison of diagnostic value of ultrasound elastography and fine needle aspiration biopsy. Health Science Reports, 6(10), e1619.

https://doi.org/10.1002/hsr2.1619

Yang, X., Zhai, D., Zhang, T., & Zhang, S. (2020). Use of strain ultrasound elastography versus fine-needle aspiration cytology for the differential diagnosis of thyroid nodules: a retrospective analysis. Clinics, 75, e1594.

https://doi.org/10.6061/clinics/2020/e1594

Yavuz, A., Akbudak, İ., Üçler, R., Özgökçe, M., Arslan, H., & Batur, A. (2021). Comparison of efficiencies between shear wave elastography, fine-needle aspiration biopsy and american college of radiology thyroid imaging reporting and data system scoring system in determining the Malignity potential of solid thyroid nodules. Ultrasound Quarterly, 37(2), 155–160.

https://doi.org/10.1097/ruq.0000000000000531

Yoo, M. H., Kim, H. J., Choi, I. H., Park, S., Yun, S., Park, H. K., Byun, D. W., & Suh, K. (2021). Efficacy of differential diagnosis of thyroid nodules by shear wave elastography—the stiffness map. Journal of the Endocrine Society, 5(11), bvab154.

https://doi.org/10.1210/jendso/bvab154

Zhang, Y., Lu, F., Shi, H., Guo, L.-H., Wei, Q., Xu, H.-X., & Zhang, Y.-F. (2022). Predicting malignancy in thyroid nodules with benign cytology results: The role of Conventional Ultrasound, Shear Wave Elastography and BRAF V600E. Clinical Hemorheology and Microcirculation, 81(1), 33–45.

https://doi.org/10.3233/ch-211337