Trial reportThe Journal of clinical endocrinology and metabolism2025
Diagnostic Performance of Ultrasound vs Ultrasound-Guided FNAC in Thyroid Nodules: Data From the ElaTION Trial.
Trial report in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Diagnostic Performance of Ultrasound vs Ultrasound-Guided FNAC in Thyroid Nodules: Data From the ElaTION Trial.The Journal of clinical endocrinology and metabolism · 2025Trial
- Evaluation and Management of Thyroid Nodules: A Joint Consensus Statement From the British Thyroid Association (BTA), British Association of Endocrine and Thyroid Surgeons (BAETS) and Collaborating Bodies.Clinical endocrinology · 2026Article
- Implications of the ElaTION trial for ultrasound based management of thyroid nodules.Gland surgery · 2026Article
- Reviewing secondary outcomes of the ElaTION trial for thyroid nodules.Gland surgery · 2026Article
- State of the Art on Thyroid Cancer Biology and Oncology.Biomedicines · 2026Review
- Beyond Size: Integrating Ultrasonographic Features and FNAB Cytology to Predict Thyroid Malignancy-A Retrospective, Single-Center Study.Journal of clinical medicine · 2026Article
- Improving Non-Invasive Prediction of Thyroid Nodule Malignancy: A Machine Learning-Based Clinical Approach.Cancer management and research · 2026Article
- Sonoelastography in differentiating benign and malignant thyroid nodules: A histopathological correlation.Bioinformation · 2025Article
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17 authors.
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Abstract
introductionElaTION is a large multicenter pragmatic randomized controlled trial, performed in 18 secondary/tertiary hospitals across England, comparing elastography ultrasound-guided fine needle aspiration cytology (EUS-FNAC) with ultrasound-guided FNAC (US-FNAC) alone in the diagnostic assessment of thyroid nodules. Secondary trial outcomes, reported here, assessed the accuracy of ultrasound alone (US) compared with US-FNAC to inform and update current practice guidelines.
methodsAdults with single or multiple thyroid nodules who had not undergone previous FNAC were eligible. Radiologists assessed all thyroid nodules using US alone, thereby enabling assessment of its accuracy (sensitivity and specificity) vs US-FNAC.
resultsOf the 982 participants, a final definitive diagnosis was obtained in 688, who were included in the final analyses. The sensitivity of US alone was the same as US-FNAC (0.91 [95% CI, 0.85-0.97] vs 0.87 [95% CI, 0.80-0.95] P = .37). US alone had statistically significant lower specificity than US-FNAC alone (0.48 vs 0.67 respectively, P < .0001). The malignancy rate on histology in a nodule classified as benign on ultrasound (U2) was 9/263 (3.42%) and on cytology (Thy2) was 15/353 (4.25%), whereas the malignancy rate in a nodule that was benign on both (U2, Thy2) was 3/210 (1.43%). Malignancy risk for U3, U4, and U5 nodules was 68/304 (22.4%), 43/83 (51.8%), and 29/38 (76.3%), respectively (P < .0001). Yet 80/982 (8%) patients were discharged despite having U3-U5 scans with Thy1 (nondiagnostic) FNAC and no definitive diagnosis.Malignancy risk was higher in smaller nodules: < 10 mm 23/60 (38.3%), 10-20 mm 46/162 (28.4%), and >20 mm 80/466 (17.2%) (P < .0001). Nodules with indeterminate cytology with atypical features (Thy3a) carried a similar malignancy risk to those with indeterminate cytology (Thy3/3f): 27/95 (28.4%) vs 42/113 (37.2%) respectively (P = .18).
conclusionUltrasound 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.
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