Real-Time Elastography for the Differentiation of Benign and Malignant Thyroid Nodules: A Meta-Analysis

Background: Work-up of thyroid nodules remains challenging. Fine-needle aspiration (FNA) has been shown to be the most cost-effective way to select patients for surgery with sensitivities of 54%-90% and specificities of 60%-96% for the detection of malignant lesions. Ultrasound-based real-time 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. The inclusion criteria for studies were the use of FNA cytology histopathology of surgical specimens as the diagnostic reference standard and assessment of sensitivity and specificity of RTE. The meta-analysis was performed using an inverse variance method and the Der Simonian and Laird Random effect estimator in case of established heterogeneity. Results: Eight studies that included a total of 639 thyroid nodules were analyzed. The overall mean sensitivity and specificity for the diagnosis of malignant thyroid nodules by RTE of the eight studies was 92% confidence interval 88-96 and 90% confidence interval 85-95, respectively. A significant heterogeneity was found for specificity of the different studies. Conclusions: RTE has a high sensitivity and specificity in the evaluation of thyroid nodules. This technique might be useful in conjunction or even instead of FNA to select patients with thyroid nodules for surgery.