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Summaries for the Public from recent articles in Clinical Thyroidology
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THYROID NODULES
Elastography for thyroid nodule risk stratification: does it add value beyond ACR TI-RADS?
BACKGROUND
Thyroid nodules are common, occurring in up to 50% of individuals that have imaging studies that include the neck. The main concern for evaluation of a thyroid nodule is whether or not it is a cancer. Fortunately, only ~5% of thyroid nodules are thyroid cancer. Ultrasound is the best study to evaluate thyroid nodules. Ultrasound risk-stratification systems such as the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) have attempted to standardize the evaluation of thyroid nodules and reduce unnecessary biopsies, as features on ultrasound can help to identify the risk that a certain nodule is a cancer. However, overlap in ultrasound features between benign and cancerous nodules persists.
Ultrasound elastography, which assesses tissue stiffness, has been proposed as a potential tool to improve diagnostic accuracy, as lower tissue stiffness (softer nodules) suggests that the nodule is benign. This study evaluated the performance of elastography when integrated with conventional ultrasound risk-stratification systems.
THE FULL ARTICLE TITLE
Angelopoulos N et al. Elastography enhances diagnostic accuracy of ACR TI-RADS in thyroid nodule evaluation. J Clin Endocrinol Metab. Epub 2025 Dec 18:dgaf670; doi: 10.1210/clinem/dgaf670. PMID: 41409005.
SUMMARY OF THE STUDY
This study evaluated thyroid nodules referred for thyroid biopsy according to the ACR TI-RADS recommendations. All nodules in the study underwent biopsy, but not all had definitive surgical pathology. Elastography measurements were analyzed alongside usual ultrasound features.
There were 1890 nodules concerning biopsy findings included in the study. Elastography demonstrated increased stiffness in cancerous nodules compared with benign nodules. When combined with TI-RADS classification, the results were more specific for identifying thyroid cancer. Applying elastography ratio reduced the number of recommended biopsies by 48.1% without missing any cancerous nodules. The greatest benefit was observed in intermediate-risk nodules, where elastography helped refine biopsy decisions. However, overlap in stiffness values remained.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that ultrasound elastography may provide a slight increase in diagnostic value when combined with TI-RADS, particularly in intermediaterisk nodules. Standardization and further validation are needed before widespread incorporation into routine riskstratification algorithms.
— Alan P. Farwell, MD
ATA THYROID BROCHURE LINKS
Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/
Fine Needle Aspiration Biopsy of Thyroid Nodules: https://www.thyroid.org/fna-thyroid-nodules/
Thyroid Cancer (Papillary and Follicular): https://www.thyroid.org/thyroid-cancer/
ABBREVIATIONS & DEFINITIONS
Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous.
Thyroid Ultrasound: a common imaging test used to evaluate the structure of the thyroid gland. Ultrasound uses soundwaves to create a picture of the structure of the thyroid gland and accurately identify and characterize nodules within the thyroid. Ultrasound is also frequently used to guide the needle into a nodule during a thyroid nodule biopsy.
Shear wave elastography: an ultrasound technique used to measure the stiffness of a thyroid nodule. Cancerous nodules are stiffer than benign nodules..
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