The Value Of Elastography Combined With Ultrasoud-guided Fine-needle Aspiratiaon Biopsy In TI-RADS4 Class Thyroid Nodules

Objective:To observe the value of ultrasonic elasticity(UE), ultrasoud-guided fine-needle aspiration biopsy(US-FNAB) and UE combined US-FNAB in diagnosis of TI-RADS 4 class thyroid nodules.Methods:A total of 64 patients with 69 TI-RADS 4 class thyroid nodules confirmed by pathology were enrolled, each of them accepted the US-FNAB and UE examination from October 2013 to October 2015. UE positive diagnostic criteria: the elastic score of 4-5 was considered as malignant, and the score of 1-3 was considered as benign.US-FNAB positive diagnostic criteria: cytologic diagnosis of malignant or suspicious malignant. UE combined with US-FNAB positive diagnostic criteria: UE or one US-FNAB which was positive. Surgical pathology was the gold standard, Then the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), accuracy of three methods(UE, US-FNAB, UE combined US-FNAB) were calculated and compared.Results: 49 malignant and 20 benign thyroid nodules were proven by pathology. The elastic score of 4-5 was 39, and the score of 1-3 was 30. US-FNAB cytology diagnosis of malignant 40, 7 suspicious malignant, benign 20, can not definite diagnosis of two.The sensitivity, specificity, PPV, NPV and accuracy of UE in diagnosis of TI-RADS 4 class thyroid nodules were 73.5%(36/49), 85.00%(17/20), 92.31%(36/39), 56.67%(17/30) and 76.81%(53/69). US-FNAB in diagnosis of TI-RADS 4 class thyroid nodules sensitivity, specificity, PPV, NPV and accuracy was 89.80%(44/49), 85.00%(17/20), 93.62%(44/47), 77.27%(17/22) and 88.41%(61/69). While UE combined with US-FNAB in diagnosis of TI-RADS 4 class thyroid nodules sensitivity, specificity, PPV, NPV and accuracy was 95.92%(47/49), 80.00%(16/20), 92.16%(47/51), 88.89%(16/18), 91.30%(63/69).Conclusion:UE is one of the methods to determine the properties of thyroid nodules, and it has a certain accuracy. US-FNAB as another important inspection method, which is economic, safe and accurate. While UE combine with US-FNAB have a higher accuracy.