• Saba Sohail and Sameera Kaliq Uz Zaman.
• Department of Radiology, Dow Medical College, Dow University of Health Sciences and DRKP Civil Hospital, Karachi, Pakistan.
• J Coll Physicians Surg Pak. 2020 Jul 1; 30 (7): 683-687.

ObjectiveTo determine the diagnostic accuracy of mean elasticity index (Emean) on quantitative shear wave elastography (SWE) in detection of malignancy in small solid suspected malignant thyroid nodules on ultrasound, taking histopathology as the gold standard.Study DesignAnalytical study.Place And Duration Of Study Department of Radiology, Dow Medical College, Dow University of Health Sciences (DUHS) and Dr. Ruth K. M. Pfau Civil Hospital, Karachi from September 2017 to March 2018.MethodologyAdult patients of either gender with suspected malignant thyroid nodules (solid, ≤10 mm) were subjected to SWE examination. All patients underwent thyroid surgery later. Histopathological findings were used as the gold standard for determining sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, at a cut-off Emean of 66 kilo pascals (KPa). These values were further stratified for gender, age (below or above 40 years), single or multiple nodule(s), and known duration of nodules (more or less than 10 months).ResultsThe average age of 109 women (69.43%) and 48 men (30.57%, n=157) was 37.64 ±9.44 years. The mean nodule size was 6.83 ±3.16 mm. The overall sensitivity, specificity, PPV, NPV and accuracy of the studied parameter in detection of malignancy was 81.5%, 92.3%, 68.8%, 96% and 90.5%, respectively. Diagnostic accuracy was higher for females, age over 40 years, single nodule, and known duration for longer than 10 months.ConclusionEmean - a quantitative SWE parameter - showed high diagnostic accuracy in predicting thyroid malignancy, particularly in older adults with sub-cm solid nodules of more than 10 months duration. Where available, SWE should be used to complement routine thyroid ultrasonography, which may be helpful to reduce unnecessary intervention. Key Words: Mean elasticity index (Emean), Thyroid nodule, Malignancy, Shear wave elastography, Solid nodule.

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