The Application Of Ultrasound- Guided Fine Needle Aspiration In The Diagnosis Of Thyroid Nodules

Objective To explore the application of ultrasound- guided fine needle aspiration(US-FNA) in the diagnosis of thyroid lesions, and evaluate the diagnostic accuracy of US-FNA cytology(US-FNAC) combined with thyroid imaging reporting and data system(TI-RADS) and US-FNA with immunocytochemical expression of galectin-3 and HBME-1.Methods Part Ⅰ: From November, 2012 to January, 2015, 273 thyroid nodules in 243 patients with US-FNAC were enrolled in the retrospective study,which were pathologically confirmed by surgery.We classified these nodules by the TI-RADS, UItrasonographic category findings and cytological findings were compared with histological results. To evaluate the diagnostic accuracy of US-FNAC using the receiver operating characteristic curve(ROC curve), and compare the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US-FNAC independent diagnostic and combine TI-RADS diagnostic.Part Ⅱ: From December, 2014 to March, 2015, 78 thyroid nodules and 2 glands scattered strong-echogenic point in 72 patients with US-FNAC were enrolled in the prospective study,Conventional smears and liquid-based Thin Prep smears were made. The former were used to HE staining for pathological diagnosis, and the latter were to immunocytochemistry examination for detection Galectin-3 and HBME-1. The cytopathology results and immunocytochemistry findings compared with histopathologic findings.Results Part Ⅰ: The area under the ROC curve of US-FNAC diagnosis was 0.949(95% CI, 0.923-0.974), diagnostic accuracy was high, with statistically significant., The malignancy rate of 90 indeterminate thyroid nodules was 60%(54/90), and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 64.8%(35/54), 83.3%(30/36), 85.4%(35/41), 61.2%, 72.2%(65/90), respectively. In the indeterminate thyroid nodules, the negative predictive value of FNAC negative with TI-RADS 2/3a was 96.3%(26/27), and the positive predictive value of FNAC positive with TI-RADS 3b/3c/4 was 100 %(30/30).Part Ⅱ: 47 patients(51 nodules, one case of diffuse hyperechoic point) were pathologically confirmed by surgery in the 72 patients. According to histopathological diagnosis, there were 43 papillary thyroid carcinomas, 8 nodular goiters, 1 thyroid adenoma. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of Galectin-3 and HBME-1 independent diagnostic were 85.7%, 75.0%, 94.7%, 50.0%, 84.0% and 88.1%, 87.5%, 97.4 %, 58.3%, 88.0%,respectively. Results for Galectin-3(+) or HBME-1(+) cases favored malignant or benign disease with sensitivity, specificity, negative and positive predictive values and accuracy of 97.6%, 62.5%, 93.2%, 83.3% and 92.0%, respectively; and results for Galectin-3(+) and HBME-1(+) cases favored malignant or benign disease with sensitivity, specificity, negative and positive predictive values and accuracy of 76.2%, 100.0%, 100.0%, 44.4% and 70.0%, respectively.Conclusions Part Ⅰ: US-FNAC combined with TI-RADS can effectively improve the preoperative diagnosis of thyroid nodules rate, then give a reasonable treatment recommendations, which may reduce some unnecessary duplication and excessive fine needle aspiration surgery.Part Ⅱ: Combined detection of Galectin-3 and HBME-1 expressing in liquid-based FNA smears help differentiate the benign nodules from malignant neoplasm, which may provide new ideas for the preoperative identification of benign and malignant thyroid nodules.