The Value Of TI-RADS4-5 Combined With TPOAb OR TgAb In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective:To evaluate the value of TI-RADS combined with TPOAb and TgAb in the diagnosis of benign and malignant thyroid nodules.The aim is to detect more malignant thyroid nodules by non-invasive examination.Methods:The medical records of 360 patients with thyroid nodules in our hospital from January 1,2017 to October 1,2021 were retrospectively analyzed.All patients with thyroid nodules underwent thyroid color ultrasound examination and thyroid function such as serum TSH,TPOAb and TgAb tests respectively.Gender,age,serum TSH、TPOAb、TgAb level,TI-RADS classification and pathological examination results of patients were collected.According to pathological examination results,191 cases were divided into malignant thyroid nodule group and 169 cases were benign thyroid nodule group.SPSS 22.0 statistical software was used to analyze and calculate the sensitivity,specificity,accuracy of TI-RADS,serum TPOAb,TgAb and combined diagnosis of thyroid malignant nodules.ROC curves of TI-RADS,TPOAb,TgAb and combined diagnosis of malignant thyroid nodules were plotted respectively,and the optimal cut-off value was obtained by calculating AUC.The combined diagnosis efficiency was evaluated and the independent risk factors of malignant thyroid nodules were screened by Logistic regression analysis.Results:1.Pathological types:191 cases of malignant thyroid nodules,including 184 cases of PTC（96.34%）,1 case of FTC（0.52%）,5 cases of MTC（2.62%）,and 1 case of thyroid leiomyosarcoma（0.52%）.There were 169 cases of benign thyroid nodules,130 cases of nodular goiter（76.92%）,1 case of thyroid tuberculosis（0.59%）,4 cases of subacute thyroiditis（2.37%）,18 cases of thyroid adenoma（10.65%）,15 cases of Hashimoto’s thyroiditis（8.88%）,and 1 case of granuloma thyroiditis（0.59%）.2.Basic information of patients: Gender: The prevalence of thyroid nodules in females was significantly higher than that in males,and the detection rate of malignant thyroid nodules in males was significantly higher than that in females（P = 0.002）.Age: The age of onset of malignant thyroid nodules was less than that of benign thyroid nodules（P=0.001）.3.Laboratory tests: Univariate and multivariate analysis suggested that high level of TSH,TPOAb positive,TgAb positive,higher TI-RADS grade,male,younger age were independent risk factors for malignant thyroid nodules.4.Combined diagnosis: 1)When TI-RADS combined with TPOAb were used in the segmented differential diagnosis of thyroid gland nodule,AUC was 0.828,sensitivity 89.0%,specificity 66.9%,positive predictive value 75.2%,negative predictive value 84.3% and accuracy 78.6%.The diagnostic efficiency was better than TI-RADS alone（P =0.0278）.2)When TI-RADS combined with TgAb segmented differential diagnosis of thyroid nodule nature,AUC was 0.831,with sensitivity of 86.4%,specificity of 67.5%,positive predictive value of 75.0%,negative predictive value of 81.4% and accuracy of 77.5%.The diagnostic efficiency was better than TIRADS alone（P =0.0037）.3)When thyroid nodule is TI-RADS 4b and TPOAb antibody is in the range of 100-500 U/L,or TgAb level ≥100 IU/L and TI-RADS 4C or 5,the detection rate of malignant thyroid nodule is high regardless of antibody level.It is recommended to confirm the nature of thyroid nodule by early puncture biopsy.Conclusion: 1.TPOAb,TgAb and Ti-RADS have differential diagnostic value for thyroid nodules,and TI-RADS combined with TPOAb and TgAb can improve the diagnostic value.2.Positive TgAb and positive TPOAb are independent risk factors for malignant thyroid nodule.