Endocrine Abstracts

Fine needle aspiration (FNA) is recommended for diagnosing thyroid nodules with suspicious ultrasound (US) features. Bethesda categories III and IV have conflicting management approaches: follow-up or thyroidectomy. This study aimed to evaluate a multimodal US assessment of the lesions in order to clarify the therapeutic strategy in intermediate cytology cases. 64 successive Bethesda III or IV cases were included. US evaluation consisted of greyscale US, qualitative strain elastography (SE) and three-dimensional (3D) Color-Doppler. A linear multifrequency probe and a linear volumetric probe (Hitachi Preirus Machine, Hitachi Inc. Japan) were used. The nodules were described usingconventional US criteria: taller-than-wide shape, marked hypoechogenicity, irregular borders, inhomogeneity, microcalcifications and the presence/absence of suspicious lymph nodes. Lesions presenting with increased stiffness on SE (scores 3 and 4) and moderate/intense perinodular vascularization were consideredto associate an increased risk of malignancy. Based on these criteria, lesions were classified as low, intermediate, or high risk. The outcomes were compared to the pathology report post-thyroidectomy. Thyroid cancer was identified in 25% (16 cases) and borderline follicular neoplasia was found in five cases. Given the recommendation of watchful waiting in this category, it was considered together with the malignant lesions, resulting in a number of 21 cancer cases. SE alone detected thyroid cancer with an accuracy of 82.81% (54/64 cases), a proportion of 80% of the nodules displaying score 4 and 66.6% of score 3 cases proved malignant. Most of the proven malignant nodules (15/21) showed important vascularization in the surrounding tissue. The prevalence of cancergrew with the degree of stiffness (9.0%–15.0%–66.6%–80.0%), but also with the intensification of vascular perinodular pattern (18.2%–27.7%–35.29%–50.0%). The multimodal US evaluation of intermediate cytology cases, including B-mode, SE, and volumetric Doppler demonstrated a sensitivity of 85.7%, a specificity of 88.3%, and an accuracy of 90.3% in identifying thyroid malignancy. The detection ofhighly suspicious featuresusing qualitative SE, and 3D Doppler in addition to the conventional ones, did increase the risk of cancer.