Differential Diagnosis Of Thyroid Nodules With Conventional Ultrasound Combined With Contrast-enhanced Ultrasound:A Comparative Study With Pathology

BackgroundThe detection rate of thyroid nodules,especially the detection rate of papillary thyroid cancer has increased in recent years with the development of ultrasound technology,especially the high frequency ultrasound.But there is no significant change in mortality.Therefore,how to provide more accurate and scientific examination results for patients with thyroid nodules and clinicians is becoming more and more important.Preoperative evaluation of thyroid nodules is of important guiding significance for further diagnosis and treatment of thyroid nodules.With the development of computer technology,the application of various new ultrasonic techniques has improved the accuracy of diagnosis of thyroid nodules.However,how to differentiate benign and malignant thyroid nodules is still a challenging work in many clinical practice of ultrasound doctors.Ultrasound technology is also regarded as a revolution in ultrasound technology,thanks to the development of ultrasound contrast agent is developed,the reliability and safety of ultrasound technology is improved,and has become a hot research field of ultrasound in recent years,primarily in the liver and heart disease diagnosis accounted for more,with further research,the diagnosis is also gradually applied in the thyroid,breast and lymph nodes of superficial organ diseases.The doctor was no longer satisfied with ultrasound color Doppler(CDFI)which provides information about blood flow(diameter > 100 m artery and vein),and microbubbles can make the parenchymal microvascular(diameter less than 10 micron)imaging.Ultrasonography of thyroid nodules provides a noninvasive and reliable method for the noninvasive assessment of the blood supply of thyroid nodules.ObjectiveBy using conventional ultrasound and conventional ultrasound with CEUS to differential diagnosis the benign and malignant thyroid nodules.Then compare the conventional ultrasound and two combined diagnostic methods’ results with pathological findings.Then assess the application value by using conventional ultrasound with CEUS to differential diagnosis the thyroid benign and malignant nodules.Material and methodsNinety-four thyroid nodules were collected from seventy-nine patients with thyroid nodules from June 2015 to October 2016 in the Department of thyroid surgery or Department of endocrinology in Henan Province People’s Hospital.All the thyroid nodules were examined by routine gray-scale ultrasonography and contrast-enhanced ultrasonography.And all thyroid nodules were confirmed by pathology or fine needle biopsy.The ultrasonographic features of thyroid nodules were observed and recorded.Two ultrasound diagnosticians were independently and blindly diagnosed the benign and malignant thyroid nodules.The results of routine ultrasound and ultrasonography were compared of those hyroid nodules.The sensitivity,specificity,accuracy and positive predictive value of the two methods were compared.P < 0.05,the difference was statistically significant.ResultsNinety-four thyroid nodules were confirmed by surgery or fine needle biopsy.Among them,39 were benign nodules,14 were thyroid adenoma,20 were nodular goiter,3 were atypical hyperplasia,2 were chronic lymphatic thyroiditis,55 were malignant nodules,and the pathological types were papillary thyroid carcinoma.Conventional ultrasound diagnosis of benign thyroid nodules 53,malignant nodules 41;conventional ultrasound combined with contrast-enhanced ultrasound diagnosis of benign thyroid nodules 55,malignant nodules 39.The sensitivity,specificity,and accuracy of conventional ultrasound in the differential diagnosis finding of thyroid nodules were 80%,76.9%,78.7%,respectivly.And the positive predictive value,the negative predictive value were 83%,76.9% respectivly.The sensitivity,specificity,and accuracy of conventional ultrasound combine with contrast-enhanced ultrasound in the differential diagnosis finding of thyroid nodules were 94.5%,92.3%,93.6%,respectivly.And the positive predictive value,the negative predictive value were 94.5%,92.3% respectivly.The consistency of conventional ultrasound diagnosis between a doctor and a B doctor was Kappa(conventional)=0.849(P=0.055),and the consistency of conventional ultrasound and contrast-enhanced ultrasonography was Kappa(combined)=0.828(P=0.058).ConclusionThe sensitivity of benign ultrasound combined with contrast-enhanced ultrasonography in the differential diagnosis of thyroid nodules was higher than that in conventional ultrasound.Thyroid nodular contrast echocardiography mostly enhanced boundary unclear,uneven enhancement and low enhancement,and benign nodules are different.Thyroid benign nodules and more consistent with the gland uniform and other enhanced and enhanced,or ring enhancement,and malignant nodules are different.The use of conventional ultrasound combined with ultrasound imaging diagnosis of thyroid benign and malignant nodules in the differential diagnosis of a certain value.Contrast-enhanced ultrasonography is a method that can provide more reliable supplementary information for the differential diagnosis of benign and malignant thyroid nodules.The application prospect is good.