Shear Wave Ultrasound Elastography in Noninvasive Diagnosis of Thyroid Nodules

This study is enrolling participants by invitation only.
Information provided by (Responsible Party):
Manjiri Dighe, University of Washington Identifier:
First received: December 12, 2012
Last updated: October 23, 2013
Last verified: October 2013

Shear wave ultrasound elastography is a new technique of finding the softness or hardness in tissue by applying a "push" generated by the machine. This technique will help in diagnosing malignancy in the thyroid gland without biopsy and avoiding biopsy in noncancerous nodules.

Condition Intervention
Thyroid Nodule
Device: SWUS Elastography

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: Efficacy of Shear Wave Ultrasound Elastography in Noninvasive Diagnosis of Thyroid Nodules

Resource links provided by NLM:

Further study details as provided by University of Washington:

Primary Outcome Measures:
  • Correlating stiffness from the SWUS elastography with indentometer and pathology findings [ Time Frame: Up to 2 months. A one-time SWUS elastography will be performed on Day 1 within 2 months prior to the patients scheduled clinical FNA or surgery. ] [ Designated as safety issue: No ]

    SWUS elastography can provide an objective score of stiffness, i.e., the Elasticity Index.

    Stiffness from the SWUS elastography will be correlated with the elasticity measured with an indentometer to validate the Elasticity Index. The Elasticity Index will also be correlated with the histopathologic diagnosis. The sensitivity and specificity of the method for the diagnosis of malignancy will be assessed.

Secondary Outcome Measures:
  • Correlating SWUS findings with routine US findings [ Time Frame: Up to 2 months. A one-time SWUS elastography will be performed on Day 1 within 2 months prior to the patients scheduled clinical FNA or surgery. ] [ Designated as safety issue: No ]
    The investigators will compare the SWUS findings to the routine US findings. This will help us develop criteria based on combined findings to decide if a thyroid nodule is suspicious enough to warrant a FNA biopsy. These criteria can then be used for future prospective studies.

Estimated Enrollment: 175
Study Start Date: November 2012
Estimated Study Completion Date: July 2014
Estimated Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: SWUS Elastography
This is a noninvasive technique using focused ultrasonic beams (pushing beams.) Several pushing beams at increasing depths are transmitted to generate a quasi-plane shear wave frame that propagates throughout the imaging area. After generating the shear wave, an ultrafast imaging sequence is performed to acquire successive raw radiofrequency dots at a very high frame rate (up to 20,000 per second). A tissue elasticity assessment can be derived from shear wave propagation speed. A color-coded image is displayed; softer tissue in blue and stiffer tissue in red. Quantitative information is delivered by drawing regions of interest on the thyroid and surrounding tissues which is the Elasticity Index expressed in kilo-Pascal (kPa). Due to the lack of manual compression and known value of the strength of pushing beam, SWUS gives an objective number to stiffness within the nodule.
Device: SWUS Elastography
Other Name: Aixplorer Ultrasound System (SuperSonic Imagine, Inc)

Detailed Description:

Thyroid nodules are a common medical problem. With the wide use of various imaging modalities, incidentally detected thyroid nodules are becoming more common. However most of these nodules are benign with only a small proportion of 5-10% being malignant. With the increasing number of nodules detected, evaluation of these thyroid nodules presents a diagnostic challenge since the imaging modality used for evaluation at present, i.e., ultrasound (US) alone, has a low specificity of approximately 50-70%. In order to improve specificity to confidently diagnose malignancy in the thyroid nodule, a fine needle aspiration (FNA) biopsy is performed.

In recent years, US elastography has been shown to have high specificity of 90- 98% in various studies in differentiating between benign and malignant nodules. US elastography works on the principle of detecting the stiffness within a tissue by applying compression which can be manual compression or by generation of a remote radiation force by focused ultrasonic beams called as shear waves. Shear Wave Ultrasound (SWUS) elastography is an objective method of US elastography that detects the stiffness within the nodule since the strength of the shear wave generated is known and can be controlled. SWUS elastography has shown promise in being able to noninvasively diagnose papillary carcinoma in previous studies involving preoperative patients.

The investigators propose to perform a study to investigate the efficacy of SWUS elastography in diagnosing malignant thyroid nodules and noninvasively decreasing the number of FNAs performed by avoiding FNA in benign nodules. The Investigators will enroll patients with thyroid nodules before they undergo FNA biopsy or surgery. We also propose to compare routine US and SWUS elastography and their combined use in differentiating malignant from benign nodules. The investigators hypothesize that SWUS elastography can be used as a noninvasive screening tool, prior to an FNA, to screen out benign and malignant nodules with high level of confidence and reduce the number of biopsies in the future.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of thyroid nodule
  • Referred for thyroid FNA or surgery

Exclusion Criteria:

  • Minors; age <18
  • Unable to provide informed consent
  Contacts and Locations
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Please refer to this study by its identifier: NCT01757834

United States, Washington
University of Washington Medical Center
Seattle, Washington, United States, 98195
Sponsors and Collaborators
University of Washington
Principal Investigator: Manjiri K. Dighe, MD University of Washington
  More Information


Responsible Party: Manjiri Dighe, Associate Professor of Radiology, University of Washington Identifier: NCT01757834     History of Changes
Other Study ID Numbers: 41443-EA, 1R21CA164112-01
Study First Received: December 12, 2012
Last Updated: October 23, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by University of Washington:
Thyroid Nodule
Thyroid Neoplasm
Differential Diagnosis
Elasticity Imaging Technique

Additional relevant MeSH terms:
Thyroid Diseases
Thyroid Nodule
Endocrine Gland Neoplasms
Endocrine System Diseases
Head and Neck Neoplasms
Neoplasms by Site
Thyroid Neoplasms processed this record on October 29, 2014