In this chapter, we present several cases in which elastography was performed. Most of these studies are presented elsewhere on the website. We give a brief summary of Elastography which has been prepared by dr. Zoltan Palotas.

Some thoughts about elastography

Elastography is a tool which measures the rigidity or stiffness of an anatomical structure. The hard consistency of a nodule is very long known as a suspicious sign of thyroid cancer. The real benefit of the introduction of elastography may be that the consistency of the nodule can be established even in the case of non-palpable nodules. As happened in many cases, the first papers on the use of elastography in thyroid nodules, led to high but later unfulfilled hopes. Essentially, none of the relevant TIRADS systems involve nodule' rigidity into the suspicious characteristics.

There are certainly two independent reasons why elastography did not live up to expectations. The first relies on technical issues. It is difficult to standardize the results which causes a relatively high interobserver disagreement when judging an elastography pattern.

The second relies on the change in our approach. In contrast with the former era when the goal was to recognize all possible malignant thyroid nodules, our current approach is significantly different. E.g., except for very rare cases, none of the guidelines suggest thyroid ultrasound in patients who hasn't goiter or palpable nodules because it became evident, that the non-recognition of nonpalpable cancers shares minimal risk for the patient. Essentially, overwhelming majority of non-palpable nodules do not require the previously applied diagnostics, i.e., the only real advantage of elastography has lost its importance.

One more consideration. It is worth comparing the current role of vascularity and elastography. Both tools initially seemed capable of distinguishing between benign and malignant nodules. However, for various reasons, we do not use any of them for this purpose. However, the evaluation of vascularity remained an essential part of the ultrasound examination because we take advantage of this in many very different situations. On the other hand, elastography can be abandoned without further ado.

This does not mean that it is completely unnecessary to examine the rigidity of the nodule. On the one hand, we cannot rule out the possibility that technical standardization will be resolved and will be put in place over time. On the other hand, in certain cases, we surely can take advantage of the technique, primarily in non-palpable nodules. Moreover, compared to the ideal conditions assumed by the guidelines, the reality can be quite different. E.g., there may be research groups for whom the cytological examination is highly limited, and they need to consider much more carefully on whom they perform this. It is much easier to purchase a software for a few thousand euros, than to apply a good cytopathologist.

 

 

 

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