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A total of 277 PTC nodules from 245 patients were included. SE demonstrated higher consistency with pathology compared to US (Kappa value: 0.735 vs. 0.562, <jats:italic>p<\/jats:italic>\u2009=\u20090.000, respectively). SE also showed superior specificity (91.4% vs. 74.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.000) and accuracy (87.7% vs. 78.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003) in diagnosing ETE. The area under the curve for SE was significantly higher than for US (0.865 vs. 0.798, <jats:italic>p<\/jats:italic>\u2009=\u20090.006). Age and calcification influenced SE's diagnostic performance. 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