Utility of shear-wave elastography in addition to ultrasonography in evaluation of thyroid nodules: Correlation with cyto-histopathological findings

Background: Thyroid nodules are common clinical findings, and accurate prebiopsy characterization is essential as approximately 5%–15% harbor malignancy. This study evaluates the utility of shear-wave elastography (SWE) as an adjunct to conventional ultrasonography (USG) in differentiating benign from malignant thyroid nodules, with cyto-histopathological correlation. Materials and Methods: This prospective hospital-based observational study was conducted in the Department of Radiodiagnosis, Kalinga Institute of Medical Sciences, Bhubaneswar, from January 2024 to December 2025. Eighty-four consecutive patients with thyroid nodules undergoing cyto-histopathological evaluation were assessed using gray-scale USG with American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) scoring and quantitative SWE (GE LOGIQ P9, 6–15 MHz linear transducer). Cyto-histopathological diagnosis served as the reference standard. Statistical analysis included Chi-square and Fisher’s exact tests, Mann–Whitney U -test, and receiver operating characteristic curve analysis with Youden index; 95% confidence intervals were calculated. SPSS version 24.0 was used, with P < 0.05 considered significant. Results: Of 84 nodules, 63 (75%) were benign and 21 (25%) malignant. Mean elasticity index (EI) was significantly higher in malignant nodules (116.8 ± 45.5 kPa) than benign nodules (39.9 ± 21.7 kPa; P < 0.05). At an optimal EI cut-off of 71.23 kPa (area under the curve [AUC] 0.814), SWE achieved sensitivity 66.7%, specificity 90.5%, and accuracy 84.5%. Combined TI-RADS + SWE improved diagnostic performance: sensitivity 90.5%, specificity 90%, negative predictive value (NPV) 96.6%, and accuracy 90.5% (AUC 0.937). Conclusion: SWE significantly enhances diagnostic accuracy when combined with TI-RADS-based USG. The high NPV suggests that soft-stiffness TI-RADS 3 and 4 nodules may be considered for conservative surveillance rather than immediate cyto-histopathological workup.