Study Of Contrast Enhanced Ultrasound Combined With Ultrasound-guided Fine-needle Aspiration In Differentiating Malignant And Benign Thyroid Nodules

Objective:To evaluate the diagnostic value of contrast enhanced ultrasound(CEUS)combined with ultrasound-guided fine-needle aspiration(US-FNA)in differentiating malignant and benign thyroid nodules.Methods:From January 2015 to December 2016,a retrospective review of preoperative CEUS and US-FNA data of 161 thyroid nodules confirmed by surgical pathology from 145 patients was performed.Take the CEUS enhancement patterns of whole phase hypo-enhancement,uneven hypo-enhancement and early phase hypo-enhancement as the diagnostic criteria for malignant thyroid nodules.According to the Bethesda System,take the grade?? as the criteria for diagnosis of malignant thyroid masses.The 161 thyroid nodules were divided into group A(the longest diameter of thyroid nodules were higher than 1cm)and group B(the longest diameter were higher than 0.5cm but lower than1cm).The sensitivity,specificity,accuracy,positive and negative predictive value of CEUS,US-FNA and the combination were evaluated respectively in the the two groups.Results:In the 161 thyroid nodules,the sensitivity of CEUS,US-FNA and the combination were 75.2%,80.3%,94.0%,respectively;The specificity were 90.9%,100%,90.9%,respectively;The accuracy were 80%,86%,93%,respectively;The positive predictivevalue were 95.6%,100.0%,96.5%,respectively.The negative predictive value were58.0%,65.7%,85.1%,respectively.There were no statistically difference in sensitivity between CEUS and US-FNA(P=0.417),the combination has the highest sensitivity.There were no statistically difference in specificity among CEUS,US-FNA and the combination.In group A,the sensitivity of CEUS,US-FNA and the combination were 88.0%,81.3%,94.7%,respectively;The specificity were 88.5%,100%,88.5%,respectively;The accuracy were 88%,86%,93%,respectively;The positive predictive value were 95.7%,100.0%,95.9%,respectively.The negative predictive value were 71.9%,65.0%,85.2%,respectively.There were no statistically difference in sensitivity between CEUS and US-FNA(P=0.301),the combination has the highest sensitivity.There were no statistically difference in specificity among CEUS,US-FNA and the combination.In group B,the sensitivity of CEUS,US-FNA and the combination were 52.4%,78.6%,92.9%,respectively;The specificity were 94.4%,100%,94.4%,respectively;The accuracy were 65%,85%,93%,respectively;The positive predictive value were 95.7%,100.0%,97.5%,respectively.The negative predictive value were 45.9%,66.7%,85.0%,respectively.There were statistically difference in sensitivity between CEUS and US-FNA(P<0.05),the combination has the highest sensitivity.There were no statistically difference in specificity among CEUS,US-FNA and the combination.Conclusion:1.For thyroid nodules whose longest diameter higher than 1cm,there were no statistically difference in sensitivity between CEUS and US-FNA.The combination had higher sensitivity than US-FNA.2.For thyroid nodules whose longest diameter higher than 0.5cm but lower than1 cm,US-FNA provided higher sensitivity than CEUS,the combination provided higher sensitivity than single CEUS or US-FNA.