I use it for research in thyroid nodules and we haven't started using it as a routine in our clinical practice. I think we need some more evidence and larger studies before we can start using elastography clinically. Perhaps people in Europe and Asia are using it clinically in thyroid. I think the best use of elastography in thyroid would be in multiple nodules - ultrasound would of course help in these cases by evaluating the individual nodules for suspicious features but there might be some role for elastography as well.

I agree with Manjiri, I don't think elastography should be an alternative to ultrasound, rather it should be an adjunct to the standard US used in clinics. Elastography has a higher specificity for nodules less than 1 cm. There is a high possibility of false positive results during examination of nodules with cystic consistency, coalescent nodules or nodules with fibrosis due to previous thyroid disorders. A final note, which is worth investigating, maybe elastography can play a role in better risk stratifying indeterminate nodules, the ones we cannot reconcile with ultrasound, cytology, and using molecular markers.

Thanks for u comments!

Do u think elasto can replace FNAB in some cases? Which cases u guess?

Which elasto-system u use? with quantification or just subjective evaluation?

It can only be one more diagnostic tool to make a better decision. Perhaps it can reduce the number of unnecessary biopsies but it cannot replace FNAB.

I use the Supersonics, Aixplorer system for thyroid. We just bought a Phiilps, EPIQ system as well, but they haven't optimized the linear transducer for thyroid.

I agree with both Mostafa and Salem in that elastography can decrease the number of FNAs being done.

Thanks for comments. We have been using elasto since 4 years in our Institution. Only the last one from supersonics, aixplorer seems to be appropriate and standardized for thyroid Imaging, but still no idea which cases can be reduced by elasto!

Dear Manjiri, what are u normal ranges and cut-off for pathological consistency with aixplorer?

Jamshed - I use Supersonics for research and am just finishing my data collection. I don't use it for clinical purpose. Once the data is collected I will analyze it - so I cannot give you the answer. From literature it seems that people have reported using 60kpa and one paper uses about 40 kpa for benign versus malignant nodules.

I think, the combination of elastography and USG-FNAC- minimally invasive methods  increases both sensitivity and specificity in the pre-operative diagnostics of thyroid nodules.

ok Lukas, but which criteria from FNAB and complementary elasto are useful to increase the sens. & spec. of thyroid nodule diagnosis and reduce the unnecesscary FNABs? any idea?

Dear Manjiri,

do u know any publication or any data on normal range of elasticity of healthy thyroid tissue with respect to age and gender evaluated by supersonics?

According to our observations US elastography has great importance in the selection suspect nodules for FNAB indication.  With  a high prevalence of nodules makes it difficult to use FNAB in every nodule

We have experience with this. But The literature is  equivocal  , it is very operator dependent. I am not sure it will make a major difference 

Before performing node FNAB thyroid we perform elastography for more information about the nature node

US elastography would be helpful to select target nodule for FNA or CNB; however some articles suggested that US feature is more important than thosw of US elastography. Therefore we need to validate the comparison study of US elastography and US feature.