1. A small thyroid papillary cancer The role of Shear Wave Elastography
Antonio Pio Masciotra
Campobasso – Molise – Italy
Website
YouTube Channel

2. This is the lower pole nodule, slightly hypoechoic wth a few intranodular vessels at powerdoppler.
At Shear Wave Elastography it shows a stiffness sustantially not different from the one of surrounding normal parenchyma.
51 years old asymptomatic woman at her first thyroid US exam.
Two small nodules wer found in her left lobe, one in the lower pole, the other near the isthmus.

3. This is the second nodule (8 mm in diameter and 0,2 ml in volume).
It is inhomogenehously hypoechoic, with undefined borders, taller than wide,
with small calcification and many intranodular vessels.
10-2 Mhz Linear probe MHz Linear probe MHz Linear Probe

4. This is the 3D US study
also in elastography

5. Left lobe paraisthmic nodule (kPa)
10-2 Mhz probe MHz probe MHz probe
Left lobe paraisthmic nodule (kPa)
10-2 MHz
15-4 MHz
16-5 MHz
Mean stiffness
72-104
58-72
51-71
Maximum stiffness
95-133
76-111
87-91
Minimum stiffness
71-89
26-41
1-49
Standard Deviation
9-13
9-20
11-23
Ratio
1,4
2,4-4,3
1,8

6. Lower pole nodule Paraisthmic nodule
15-4 MHZ Probe
SWE Features (kPa)
Lower pole nodule
Paraisthmic nodule
Mean stiffness
31-33
58-72
Maximum stiffness
36-43
76-111
Minimum stiffness
25-31
26-41
Standard Deviation
1-3
9-20
Ratio
1,0-1,4
2,4-4,3
Lower pole nodule Paraisthmic nodule

7. This is the FN cytology classified THY 5 highly suggestive of PTC, then confirmed at surgery.
The lower pole nodule was simply hyperplastic.

8. Keypoints of the case and ‘take home messages’
Shear wave elastography one more time shows its reliability in identifying stiff thyroid nodules also with small volume (< 1 cm) and in the guidance of the FNAC, like in this case of small PTC.
One more it shows that it can give the right indication of benignity in the case of ‘soft’ small nodules
While Papillary cancers are often stiff, follicular cancers often can be soft.
This case shows one more time that small nodules can be cancer and large nodules can be benign.

9. Thanks for your attention
A small thyroid papillary cancer
The role of Shear Wave Elastography
Thanks for your attention
Antonio Pio Masciotra
Campobasso – Molise – Italy
Website
YouTube Channel