Ultrasound Imaging Features Combined With Clinical And Biochemical Data Increase The Accuracy Of Predicting Malignant Thyroid Nodules

Background Thyroid nodule is a kind of common disease in the endocrine system.The key to diagnosis of thyroid nodule is early identification of benign and malignant nodules.Currently,the evaluation of benign and malignant thyroid nodules is mainly based on ultrasound imaging features,such as Thyroid Imaging Reporting and Data System(TIRADS)issued by the American College of Radiology(ACR)in 2017 and Thyroid Imaging Reporting and Data System created by the Superficial Organ and Vascular Ultrasound group in Chinese Medical Association(C-TIRADS)in 2020.Malignant thyroid nodules may be associated with age,sex and autoimmune disorder.But few of studies combined clinical and biochemical data of patients and ACR-TIRADS to predict malignant thyroid nodules.Objective The aim of the study is to improve the diagnostic performance in differentiating benign and malignant thyroid nodules by combining of clinical and biochemical data with American college of radiology-thyroid imaging reporting and data system(ACR-TIRADS).Method Records for 328 patients who underwent fine needle aspiration biopsy(FNAB)were analyzed.Laboratory,clinical data and ultrasound characteristics of hospitalized patients with thyroid nodule were assessed retrospectively,and the ACR-TIRADS and Chinese thyroid imaging reporting and data system(C-TIRADS)of each nodule lesion were calculated.Univariate and multivariate logistic regression analysis were performed for malignancy thyroid nodules.A comparison of the three diagnoses using ROC curves was performed.Result A total of 328 patients with thyroid nodules were enrolled,274 nodules were benign and 54 were malignant.Among all patients with nodules,78.0% were female.The age of patients with malignant thyroid nodules lower than that with benign nodules(43 ± 13 vs 49 ± 14 years,P = 0.002).BMI,fasting blood glucose,cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,Free 3,5,3’-triiodothyronine(FT3),Free thyroxine(FT4),Thyroid peroxidase antibody(TPOAb),Thyroglobulin antibody(Tg Ab),white blood cell count,absolute value of neutrophils,absolute value of lymphocytes and Neutrophil-to-lymphocyte ratio(NLR)showed insignificant difference between patients with benign and malignant nodules.The serum level of TSH was higher in patients with malignant than that with benign nodules,but they were not independent risk factors for malignant nodules.The diameter of nodules in the benign group was significantly larger than counterparts,but the diameter of nodules was not an independent risk factor for malignant nodules.The serum level of Tg Ab was significantly higher in the malignant nodule group than that with benign group.Multivariate logistic regression analysis showed that age(OR= 0.967,95%CI = 0.94-0.995,P = 0.020),Tg Ab(OR =1.001,95% CI = 1.000-1.002,P = 0.013)and ACR-TIRADS(OR = 9.903,95% CI =4.944-19.836,P< 0.001)were independent risk factors for malignancy nodule.The accuracy of combined age,Tg Ab and ACR-TIRADS were significantly higher than that of single index prediction,including C-TIRADS or ACR-TIRADS.Conclusion Age in combination with Tg Ab and ACR-TIRADS increase the prediction performance of thyroid nodules in detecting benign and malignant lesions,which is better than the evaluation of nodule by ACR-TIRADS or C-TIRADS alone.