The holy grail in management of thyroid nodules concerns how to determine benign from malignant nodules, to prevent unnecessary thyroid operations.

Shear wave elastography (SWE) is an ultrasonography technique using 2D and 3D images supported by elasticity measurements. SWE is thought to be more reproducible that earlier elastographic methods. However, Swan et al. report inter- and intrarater agreement to be low, with inter-rater agreement being lowest for malignant as opposed to benign nodules.

Diagnostic accuracy as assessed by ROC (receiver operating characteristic) analysis showed weak or no association between histological diagnosis and SWE.

In addition, there are exclusion criteria for SWE: isthmic nodules, due to high risk of artefacts from trachea, cannot be assessed by SWE, and nor can cystic nodules, as shear waves do not travel through fluid.

The authors conclude that SWE cannot differentiate benign from malignant nodules. It seems perhaps that the holy grail will be found, in part, in the recent statement from the US Preventive Services Task Force, which recommends against screening for thyroid cancer in asymptomatic adults (JAMA, 9 May 2017). Fewer US thyroids will result in far fewer thyroid nodules to assess.

Read the full article in Clinical Endocrinology 86 606–613