Diagnostic Performance of Ultrasound vs Ultrasound-Guided FNAC in Thyroid Nodules: Data From the ElaTION Trial
Authors' conclusion
Ultrasound alone appears to be an effective diagnostic modality in thyroid nodules, confirming the recommendations of recent guidelines and the British Thyroid Association classification. However, findings also suggest caution regarding existing recommendations for conservative management of nondiagnostic (Thy1/Bethesda I) and atypical (Thy3a/Bethesda III) nodules. In those cases, ultrasound (U3-U5) features may help identify high-risk subgroups for more proactive management.
Study context
- Population
- Adults with single or multiple thyroid nodules without previous FNAC, 18 hospitals in England688 analysed
- Participants
- 982 adults
- Comparison
- US alone vs US-guided FNAC
- Outcome
- Accuracy (sensitivity and specificity) of US alone vs US-FNAC
Methodological detailssecondary outcomes of the ElaTION randomised controlled trial, multicenter, pragmatic, 18 secondary/tertiary hospitals in England
- Secondary outcomes of the ElaTION randomised controlled trial
- Multicenter
- Pragmatic
- 18 secondary/tertiary hospitals in England
Performance
As reported in the abstract
| Test or model | Sensitivity | Specificity |
|---|---|---|
| US | 0.91 (95% CI, 0.85-0.97) | 0.48 |
| US-FNAC | 0.87 (95% CI, 0.80-0.95) | 0.67 |
Sensitivity
Specificity
- US vs US-FNAC: P = 0.37 — sensitivity the same
- US vs US-FNAC: P < 0.0001 — lower specificity with US
Further findings
Malignancy rate on histology in benign-classified nodules
- Benign on US (U2)
- 9/263 (3.42%)
- Benign on cytology (Thy2)
- 15/353 (4.25%)
- Benign on both (U2, Thy2)
- 3/210 (1.43%)
Malignancy risk by US category
- U3
- 68/304 (22.4%)
- U4
- 43/83 (51.8%)
- U5
- 29/38 (76.3%)
- P
- P < 0.0001
Discharged despite U3-U5 scans with Thy1 (nondiagnostic) FNAC and no definitive diagnosis
- Patients discharged
- 80/982 (8%)
Malignancy risk by nodule size
- < 10 mm
- 23/60 (38.3%)
- 10-20 mm
- 46/162 (28.4%)
- >20 mm
- 80/466 (17.2%)
- P
- P < 0.0001
- Higher in smaller nodules
Malignancy risk, Thy3a vs Thy3/3f cytology
- Thy3a
- 27/95 (28.4%)
- Thy3/3f
- 42/113 (37.2%)
- P
- P = 0.18
- Similar malignancy risk
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →