The Clinical Value Of The Combined Application Of Multimodal Ultrasound Imaging And Fine Needle Aspiration In The Diagnosis Of Thyroid Microcarcinoma

Objective:To explore the clinical value of the combined application of multimodal ultrasound imaging and fine needle aspiration in the diagnosis of thyroid microcarcinoma.Methods:A total of 161 patients with thyroid micro nodules from June 2017 to November 2018 were enrolled,a total of 183 nodules(67 benign nodules,116 malignant nodules)underwent routine two-dimensional ultrasound,contrast-enhanced ultrasound,fine needle aspiration and surgery in the Gansu provincial hospital.The surgical pathological results were used as the gold standard,the above-mentioned nodules’ contrast-enhanced contrast mode was qualitatively evaluated,and the contrast-enhanced features of benign and malignant thyroid micro nodules were compared.The diagnostic scores of the two-dimensional ultrasound,the diagnostic scores of contrast-enhanced ultrasound and the diagnostic scores of the combination of the two-dimensional ultrasound and contrast-enhanced ultrasound were used to map the receiver operating characteristic(ROC)curve,and the area under the curve were compared,the best diagnostic cutoff value were calculated and the diagnostic efficiency were compared;Contrast-enhanced ultrasound,FNA and the combined diagnosis of thyroid micro nodules’ diagnostic efficiency were analyzed comparatively;The relationship between conventional ultrasound features,contrast-enhanced ultrasonography and lymph node metastasis in 116 patients with papillary thyroid microcarcinoma confirmed by surgery and pathology were analyzed.Results:Contrast-enhanced patterns are significantly different between benign and malignant thyroid micro nodules in the degree,process and uniformity(P<0.05).Thyroid micro carcinoma mainly shows low enhancement,centripetal and heterogeneous enhancement;The area under the ROC curve of the two-dimensional ultrasound combined with contrast-enhanced ultrasound(0.933,95% confidence interval 0.887 to 0.965)is greater than the area under the ROC curve of two-dimensional ultrasound(0.827,95% confidence interval0.765 to 0.879)and the area under the ROC curve of contrast-enhanced ultrasound(0.910,95% confidence interval 0.859 to 0.947),the difference of the area under the ROC curve between the two-dimensional ultrasound and the contrast-enhanced ultrasound,the combined diagnosis are statistically significant(P=0.014,P<0.001).There is no statistical difference between the combined diagnosis and the contrast-enhanced ultrasound(P>0.05),the best diagnostic cutoff values of two-dimensional ultrasound,contrast-enhanced ultrasound and combined diagnostic score is 7.5 points,1.5 points and 9.5 points respectively,and their corresponding sensitivity and specificity are respectively(0.931,0.784,0.948),(0.642,0.910,0.761);The sensitivity,specificity,accuracy,positive likelihood ratio,negative likelihood score of fine needle aspiration,contrast-enhanced ultrasound and the combination of both for thyroid micro nodules are respectively(91.4%,73.3%,98.3%),(95.5%,92.5%,89.6%),(92.9%,80.3%,95.1%),(20.3,9.87,9.36),(0.09,0.29,0.02),Sensitivity of combined diagnosis of the two is the highest,while specificity of combined diagnosis of the two is the lowest,and the difference of sensitivity is statistically significant(P<0.05).There is no significant difference in specificity(P>0.05).The combined diagnosis accuracy of the two is the highest.The difference between the accuracy of combined diagnosis and the accuracy of contrast-enhanced ultrasound is statistically significant(P<0.05).There is no significant difference between the accuracy of FNA and combined diagnosis(P>0.05).There is a significant difference between invasion of the capsule,micro calcification and the central lymph node metastasis of thyroid papillary microcarcinoma(P<0.05),and there is no significant difference between the gender,age,nodule size,border,morphology,contrast-enhanced ultrasound mode and the central lymph node metastasis of thyroid papillary microcarcinoma(P>0.05).Conclusion:Two-dimensional ultrasound,contrast-enhanced ultrasound and FNA are valuable for the diagnosis of thyroid microcarcinoma;Contrast-enhanced ultrasound combined with twodimensional ultrasound score is more accurate than single two-dimensional ultrasound score.It can be used as a supplementary diagnosis method for two-dimensional ultrasound diagnosis of thyroid microcarcinoma;Contrast-enhanced ultrasound combined with FNA can improve the sensitivity and accuracy of differential diagnosis of benign and malignant thyroid micro nodules;There is a correlation between invasion of the capsule,micro calcification and lymphnode metastasis in the central region of papillary thyroid microcarcinoma.Therefore,multimodal ultrasound combined with FNA is helpful for the diagnosis and individualized evaluation of preoperative thyroid microcarcinoma,so as to guid its clinical treatment.