Ultrasound Multimodal Diagnostic Model And Proteomics Of Thyroid Nodules

ObjectiveTo screen out independent risk factors regarding thyroid cancer. To establish ultrasonographic multi-modality diagnostic model for thyroid nodules and to explore the diagnostic value of the model.Materials and methodsFrom November 2011 to February 2013,307 cases of patients with a total of 367 thyroid nodules underwent conventional ultrasound(CUS), contrast enhanced ultrasound(CEUS) and ultrasound elastography examination before surgery. The sonographic features of these nodules were analysed. Binary logistic regression analysis was performed to screen out independent risk factors regarding thyroid cancer, and to establish multi-modality diagnostic model for thyroid nodules. The diagnostic performance of CUS, CEUS, ultrasound elastography and the multi-modality diagnostic model were assessed and compared.Results1. Among the US characteristics, shape, border, S/L ratio, halo, echoes, echogenicity, the presence of calcifications, blood flow distribution, vascular morphology, enhancement pattern, peak intensity, and elasticity score differed significantly between malignant and benign lesions (p<0.001). Based on the OR, the most suspicious ultrasonic features were solid, irregular-shaped, elasticity score of 3/4, heterogeneous enhancement, no halo, S/L ratio≥1, the presence of microcalcifications, internal blood flow, marked hypoechoic, the presence of calcification, an ill-defined border, low enhancement, hypoechoic, and irregular blood flow distribution.2. Six independent risk factors were included in logistic regression models:shape, echogenicity, vascular morphology, enhancement pattern, elasticity score, and age.3. Among all of the CUS characteristics, irregular shape had the highest diagnostic accuracy(80.7%), with a sensitivity of 88.9% and a specificity of 68.7%; Among all of the CEUS characteristics, heterogeneous enhancement had the highest diagnostic accuracy (78.7%),with a sensitivity of 82.0% and a specificity of 74.0%. Elasticity score had a diagnostic accuracy of 78.5%, with a sensitivity of 87.1% and a specificity of 66.0%. The multi-modality diagnostic model had a diagnostic accuracy of 86.9%, with a sensitivity of 93.5% and a specificity of 77.3%. The multi-modality diagnostic model improved the diagnostic accuracy compared with CUS, CEUS and ultrasound elastography.ConclusionIndependent risk factors for thyroid cancer include shape, echogenicity, vascular morphology, enhancement pattern, elasticity score, and age. The multi-modality diagnostic model was demonstrated to be effective in the diagnosis of thyroid nodules.ObjectiveTo evaluatediagnostic value of contrast enhanced ultrasound (CEUS) of thyroid nodules coexistence with Hashimoto’s thyroiditis(HT).Materials and methodsTotally 62 thyroid nodules in 48 cases of patients with HT were retrospectively analyzed. CUES characteristics were reviewed, and diagnostic value of enhancement pattern and peak intensity were calculated.ResultsPeak intensity and enhancement pattern differed significantly between malignant and benign thyroid nodules(P=0.002, P<0.001).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of heterogeneous enhancementwere found to be 97.6%,85.7%,93.0%,94.7%, and 93.5%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of low intensity at peak time were found to be 85.4%,52.4,77.8%,64.7%, and 74.2%, respectively.ConclusionsHeterogeneous enhancement is demonstrated to be effective in the diagnosis ofmalignant thyroid nodules coexistence with Hashimoto’s thyroiditis. CEUS examination can be recommended to HT patients when we can’t differentiate malignant from benign by conventional ultrasound alone.ObjectiveTo compare the serum protein differentially expressed between papillary thyroid carcinoma (PTC), benign thyroid nodules (BTN), and healthy control (HTY) and to screen out potential biomarkers for PTC.Materials and methodsFrom May 2012 to February 2014,5 cases of PTC and BTN were selected from surgical patients of thyroid nodules in our hospital. Five cases of healthy volunteers were recruited matched by age and sex. Three groups of pooled serum samples were compared using isobaric tags in a relative and absolute quantitation(iTRAQ) proteomic approach. Functional annotations of the identified proteins were conducted using GO program. The KEGG database was used to classify and group these proteins.Results1. Fifty-two proteins were differentially expressed between the PTC patients and the BTN patients, including 35 up-regulatedproteins and 17 down-regulated proteins.54 proteins were differentially expressed between the PTC patients and the HTY, including 29 up-regulatedproteins and 25 down-regulated proteins.68 proteins were differentially expressed between the BTN patients and the HTY, including 16 up-regulated proteins and 52 down-regulated proteins.2. Analyzing difference multiples and protein function, ten potential serum biomarkers for PTC were screened out:Isoform 2 of Haptoglobin-related protein, keratin 1, ATP synthase subunit bata,60S ribosomal protein L30, eukaryotic initiation factor 4A-I, laminin subunit gamma-1, tubulin beta-8 chain, Fructose-bisphosphate aldolase A, histone H4, unidentified protein DKFZp686O12165.3. Proteins differentially expressed for PTC mainly involved in NF-kappa B signaling pathways, focal adhesion, ECM-receptor interaction pathway and primary immunodeficiency pathway.ConclusionThis preliminary study demonstrated that serum proteins expressed differentially between PTC, BTN, and HTY. However, further study is required to determine the sensitivity and specificity of these proteins with respect to their diagnostic utility.