Diagnostic Value Of Ultrasound Combined With Elastography And Thyroid Stimulating Hormone Level For Benign And Malignant Thyroid Lesions

ObjectiveTo investigate the diagnostic value of TI-RADS,elastography and serum thyroid stimulating hormone（TSH）levels in benign and malignant thyroid lesions,and to evaluate the auxiliary diagnostic Value of Elastic Imaging and Serum TSH hormone level for Ultrasound in the diagnosis of thyroid nodules.MethodsFrom March 2015 to March 2017,we collected people who underwent thyroid ultrasound examination and underwent operation or cytological puncture biopsy at the PLA Clinical College of Anhui Medical University（PLA 105th Hospital）.Serum TSH,conventional ultrasound and elastography were performed in 114 patients with thyroid nodules（127 thyroid nodules）before operation.The simple cystic nodules and the patient who preoperatively treated with I¹³¹ or with other malignant tumors was removed from research.All thyroid nodules were evaluated with the thyroid imaging reporting and data system（TI-RADS）and elastography with Itoh5 method before operation.The pathological diagnosis was taken as the gold standard to analyze the correlation between preoperative serum TSH levels and benign and malignant thyroid nodules,and the preoperative TSH levels were used to analyze the optimal threshold value of thyroid cancer.Finally,the result of TSH cut-off value was used as the thyroid nodules diagnostic criteria,the results of TI-RADS score of thyroid nodules by ultrasonic combined with preoperative serum TSH level were corrected to form the final TI-RADS score.The diagnostic value of thyroid nodules by ultrasonography and ultrasonography combined with elastography and ultrasonography combined with elastography and serum TSH levels were compared by the area under the ROC curve,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value were obtained by ROC curve.ResultsThere were 95 benign lesions and 32 malignant lesions in 127 thyroid nodules.The pathological findings showed that benign nodules included 87 nodular goiter,5thyroid follicular benign tumors and 3 chronic lymphocytic thyroiditis.Malignant Nodules include 31 thyroid papillary carcinomas,1 thyroid undifferentiated carcinoma。127 nodules were scored using the TI-RADS score,82 nodules were diagnosed as benign nodules and 45 were diagnosed as malignant nodules.With elastography,89 were benign and 38 were malignant.The preoperative serum TSH hormones were correlated only with the size of thyroid nodules by calculation（r=0.258,P<0.05）.The area under the ROC curve for the diagnosis of benign and malignant thyroid lesions was 0.61,and the optimal threshold for the diagnosis of thyroid cancer before surgery was 1.02μIU/ml.The areas under the ROC curves of pure ultrasound,elastography combined with ultrasonography and ultrasonography combined with elastography and serum TSH were 0.861,0.968 and 0.955,respectively.There was significant difference between the two combined diagnostic methods and the simple ultrasound（Z=3.12,2.97,P<0.05）,but there was no significant difference between the two combined methods（Z=1.07,P<0.05）。Ultrasound combined with elastography in the diagnosis of thyroid cancer sensitivity was 90.6%,specificity was 89.5%,accuracy was 85.2%,positive predictive value was74.3%,negative predictive value was 96.6%.Ultrasonography combined with elastography and serum TSH in the diagnosis of thyroid cancer sensitivity was 96.8%,specificity was 87.4%,accuracy was 82.2%,positive predictive value was 72.1%,negative predictive value was 75%.Conclusions Ultrasound combined with elastography can improve the value of differential diagnosis of benign and malignant thyroid lesions.The level of serum TSH is correlated with the size of thyroid nodule,and it has certain diagnostic value for thyroid carcinoma.However,as an assistant diagnostic index of ultrasound,it still needs to be further studied.