Realtime elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis
Joerg Bojunga, Eva Herrmann, Stefan Zeuzem & Mireen Friedrich-Rust
Background: Work-up of thyroid nodules remains challenging. Fine needle aspiration (FNA) has been shown to be the most costeffective way to select patients for surgery with sensitivities of 5469% and specificities of 6096% for the detection of malignant lesions. Ultrasound-based Realtime Elastography (RTE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules. A meta-analysis was performed to assess the overall performance of RTE for the differentiation of thyroid nodules.
Methods: Literature databases were searched. Inclusion criteria were: evaluation of RTE, cytology (FNA) or histology (surgery) as reference method, assessment of sensitivity and specificity of RTE. The meta-analysis was performed using the DerSimonian and Laird Random Effect estimator was used to combine results between the selected studies.
Results: Eight studies with overall 639 thyroid nodules were included in the analysis. Mean sensitivity and specificity for the diagnosis of malignant thyroid nodules were 92% (CI (88; 96), and 96% (CI (94; 97)), respectively (s. Figure). A significant heterogeneity was found for specificity of the different studies.
Discussion: RTE can be used with high sensitivity and specificity in the work-up of thyroid nodules and might be a useful method in addition to or even instead of FNA to select patients for surgery.