Diagnostic Value Of Fine-needle Aspiration Combined With Contrast-enhanced Ultrasound For Thyroid Cancer

Background:Thyroid nodules are very common clinically, if high-resolution ultrasound are used, you can find19to67%randomly selected people with thyroid nodules. Although most of the nodules belong to benign, but5%of them are malignant.Thyroid carcinoma is the most common endocrine malignancy and the incidence rate of thyroid cancer is increasing worldwide.In recent years, with the rapid development of imaging equipment and imaging technology, ultrasound has become an increasingly important imaging means of diagnosis of thyroid cancer. In addition to the conventional2D ultrasound and CDFI(color doppler flow imaging), ultrasound-guided fine needle aspiration cytology (US-FNA) and the mostly studied CEUS(contrast-enhanced ultrasound) and UE (ultrasound elastography) have also attracted a lot of attention at present. The objective of this research is to evaluate the diagnostic value of different sizes of suspicious malignant thyroid nodules by comparing FNA and CEUS.Objetive:To evaluate the diagnostic value of the ultrasound-guided fine needle aspiration biopsy (FNA) combined with contrast-enhanced ultrasound (CEUS) for thyroid carcinoma.Methods:A retrospective analysis of the clinical data of165patients was finished, including184thyroid nodules confirmed by pathology (14benign,170malignant) and their preoperative FNA and CEUS data. According to the maximal diameter of thyroid nodules, the patients was divided into group A (≤1cm) and group B (>1cm). According to the Bethesda System,> grade Ⅳ was the malignant cytologic criteria for diagnosis of thyroid nodules, and uneven low-enhanced ultrasound was the standard diagnosis of malignant thyroid. Pursuant to which, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosis for thyroid nodules by FNA, CEUS, and the combination were analyzed, respectively.Results:In group A, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of single FNA were93.8%,62.5%,92.0%,97.6%,38.5%, and CEUS diagnosis for thyroid cancer were88.5%,37.5%,85.5%,95.8%,16.7%, respectively. After FNA and CEUS were combined, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were100%、25%、95.7%、95.6%、100%, respectively. When the combined diagnosis compared with single FNA and CEUS, the sensitivity and accuracy were statistically significant (P=0.013,0.000 and P=0.000,0.000). In group B, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of single FNA were100%、83.3%、97.8%、97.6%、100%, and CEUS diagnosis for thyroid cancer were92.5%、83.3%、91.3%、97.4%、62.5%, respectively. After FNA and CEUS were combined, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were100%、66.7%、95.6%、95.2%、100%, respectively. For each pairwise comparison, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were not statistically different (P>0.05).Conclusion:For thyroid nodules≤1cm, the combined diagnosis of FNA and CEUS can significantly improve the diagnostic sensitivity and accuracy. While for thyroid nodules>1cm, the combined diagnosis does not change the diagnostic accuracy, sensitivity and specificity.