DIAGNOSTIC ACCURACY OF ELASTOGRAPHY IN PREDICTING MALIGNANT THYROID TUMOR WHILE TAKING HISTOPATHOLOGY AS GOLD STANDARD IN PATIENTS PRESENTING TO LADY READING HOSPITAL PESHAWAR

Abstract

Background: Thyroid nodules are a common clinical finding, with a subset harboring malignancy. Strain elastography has emerged as a promising non-invasive imaging modality for assessing thyroid nodules. However, histopathology remains the gold standard for a definitive diagnosis. Evaluating the diagnostic accuracy of strain elastography can aid in improving preoperative assessment and reducing unnecessary biopsies. Objective: To assess the diagnostic accuracy of strain elastography in detecting malignant thyroid nodules, using histopathology as the gold standard. Study Design: Cross-sectional validation study. Setting: Radiology Department, Lady Reading Hospital, Peshawar. Duration of Study: 27 August 2023 to 27 February 2024. Methods: A total of 110 patients aged 18 to 70 years with palpable thyroid nodules were included using consecutive sampling. Patients with prior thyroid surgery, chronic kidney disease, or pregnancy were excluded. Strain elastography was performed using a 7.5 MHz linear probe, with malignancy suspected based on features such as microcalcifications and irregular borders. Histopathological examination served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using a 2×2 contingency table. Statistical analysis was performed using SPSS version 21. Results: The study population had a mean age of 41.22 ± 15.08 years and a mean body mass index (BMI) of 25.75 ± 1.80 kg/m². Female patients comprised 54.5% of the cohort, while males accounted for 45.5%. Strain elastography identified malignancy in 53 patients (48.2%), whereas histopathology confirmed malignancy in 51 patients (46.4%). Among elastography-positive cases, 45 were true positives, and 8 were false positives. Among elastography-negative cases, 51 were true negatives, and 6 were false negatives. The diagnostic performance of strain elastography was as follows: Sensitivity: 88.24%, Specificity: 86.44%, Positive Predictive Value (PPV): 84.91%, Negative Predictive Value (NPV): 89.47%, Diagnostic Accuracy: 87.27%, Conclusion: Strain ultrasound elastography demonstrated high diagnostic accuracy in identifying malignant thyroid nodules, making it a reliable, non-invasive tool for clinical decision-making. Its integration into routine thyroid nodule assessment can enhance early detection while reducing unnecessary biopsies. Future research should focus on incorporating quantitative elastography techniques to refine diagnostic precision further.