Diagnostic Value Of Multimodality Ultrasound Imaging For Differentiation Of Benign And Malignant Thyroid Nodules

Part I Qualitative and quantitative evaluation of different size of solid thyroid nodules with contrast-enhanced ultrasoundObjective:To explore the qualitative and quantitive evaluation of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of different size of thyroid nodules(TNs).Methods:178 patients with 178 histologically proved TNs(74 benign and 104 maligant)underwent CEUS were enrolled in this study.The lesions were divided into group 1(?lcm)and group 2(>1 cm)by maximum diameter.(1)For each lesion,degree,homogeneity and process of enhancement,with or without perfusion defect,enhanced ring and boundary,shape and size of the enhanced lesions were evaluated by CEUS.The characteristics of enhancement between benign and malignant TNs were compared by Fisher exact test.ROC analyses were conducted to determine the diagnostic values of CEUS.(2)Time intensity curve(TIC)of TNs and the adjacent thyroid parenchyma were acquired with dedicated software.The various quantitative parameters were recorded including peak intensity(Peak),time to peak(TtoPk),the area under the curve(Area),etc.Then calculate the different parameter values between TNs and the adjacent thyroid parenchyma such as APeak,AArea and so on.The quantitative analysis findings of CEUS were compared by Student's t test.Results:(1)For both Group 1 and 2,contrast-enhanced patterns were significantly different between benign and malignant TNs in the degree,process,homogeneity of enhancement,shape of the enhanced lesions(P<0.05),while were not significantly different between benign and malignant TNs in the shape of the enhanced lesions.(P>0.05).Boundary,completeness of enhancement and enhanced ring were significantly different between benign and malignant TNs only in Group 1.According to ROC curve,the cut off values were both 3.5 points in Group 1 and 2.The area under the ROC curve(AUC)for CEUS was respectively 0.869(95%CI:0.806-0.932)and 0.864(95%CI:0.717-1.000).The sensitivity and specificity for CEUS in Group1 were 75.8%and 91.9%,and in group2 were 89.5%and 83.3%.(2)Peak and Area in benign TNs were higher than in maligant ones among group 1(P=0.001 and 0.014 respectively).Area,Peak and ?Peak in benign TNs were higher than in maligant ones among group 2(P=0.008,0.001 and 0.005 respectively).(2)Peak,AArea,?Peak and ?Grad in benign TNs were higher than in maligant ones among group 1(P=0.001,0.012,0.001 and 0.004 respectively).Area,Peak,?Area,and ?Grad in benign TNs were higher than in maligant ones among group 2(P=0.008,0.001 and 0.005 respectively).Conclusions:CEUS is different between benign and malignant TNs,and it assists in the differentiation diagnosis of TNs.PART ? Diagnostic value of multimodality ultrasound imaging for differentiation of benign and malignant thyroid nodulesBackground:Ultrasonography(US)is the most sensitive diagnostic tool for detecting thyroid nodules(TNs).A key limitation of US is poor differentiation of benign from malignant TNs.The new applications US elastography(USE)and contrast-enhanced US(CEUS)are used in the screening of TNs.Fine needle aspiration cytology(FNAC)is the best single diagnostic test,however,20-25%of samples are diagnosed as indeterminate.Objective:The aim of the study was to compare the diagnostic efficacy of US,USE,CEUS,and their combined use in differentiating TNs with histological diagnoses.And we investigated the diagnostic performances of combination of cytology and BRAF(V600E)mutation compared cytology alone.Methods:275 patients with 320 TNs(119 benign and 56 malignant)were prospectively enrolled.Each patient underwent US,USE,CEUS and FNAC,respectively.The diagnostic performance of the US,CEUS,USE,and combined use of three modalities were assessed and compared by the receiver operating characteristic curve(ROC)using histological as the reference method.And the diagnostic performance of combination of cytology and BRAF(V600E)mutation was calculated.Results:When comparing by ROC,AUC for combination score(0.907,95%CI:0.871?0.942)was higher than for TI-RADS score(0.763,95%CI:0.710?0.816),elasticity score(0.745,95%CI:0.687?0.803)and CEUS score(0.871,95%CI:0.828?0.913),and the difference was statistically significant between two formers(4.438,4.630,1.269;P<0.01,P<0.01,P>0.05).).The sensitivity,specificity and accuracy for the combination of three modalities were 0.908,0.754 and 0.853 respectively..The sensitivity,specificity and accuracy for the combination of cytology and BRAF(V600E)mutation were all 1,which were higher than cytology alone(0.966,0.956 and 0.962 respectively)Conclusions:The combination of US,CEUS and USE can improve the diagnostic efficacy of TNs compared with US or USE and CEUS.FNAC is the most reliable diagnostic test for thyroid nodules.The combination of cytology and BRAF(V600E)mutation enhances the accuracy of FNAC and is of particular value for TNs.