| Part 1:Differential Diagnostic Value of Real-time Elastography in Benign and Malignant Thyroid NodulesObjective:To evaluate the differential diagnostic value of real-time elastography(RTE)in benign and malignant thyroid nodules.Methods:Ninety-eight thyroid nodules in 80 patients between January 2016 and June 2017 in the Affiliated Hospital of Yangzhou University were included in this study.All patients underwent conventional ultrasound and RTE examination before ultrasound guided fine needle aspiration biopsy(FNA)or surgery.The elasticity score(ES)and strain ratio(SR)were evaluated and recorded by RTE examination.According to the pathological results,the nodules were divided into benign group(31 cases)and malignant group(67 cases).The receiver operating characteristic(ROC)curves of ES,SR and conventional ultrasound were drawn,and the performance of the three methods in differentiation of thyroid nodules was compared and analyzed.Result:On the conventional ultrasound,the echo,homogeneity,edge,boundary,acoustic halo,taller than wide(A/T)and calcification were significantly different in benign and malignant groups(P<0.01).Most of the benign nodules showed hypoechoic or isoechoic,regular margin,clear boundary and A/T<1.However,the most malignant nodules were characterized by hypoechoic,heterogeneous,irregular edge,blurred boundary,A/T ? 1,lack of halo or incomplete acoustical halo and microcalcification.The diagnostic criterion for malignancy was more than three suspicious ultrasonic characteristics yielded results with sensitivity of 86.6%,specificity of 58.I%,PPV 81.7%,NPV 66.7%and accuracy 77.6%for conventional ultrasound.Regarding RTE results,ES?2 was accounted for 77.4%in the benign group,while ES>2 was 92.5%in the malignant group.There was statistically significant difference of ES between the two groups(P<0.001).The mean SR of the benign group was 2.0 ±1.0 and that of the malignant group was 3.7 ± 1.4.The SR of malignancy was significantly higher than that of the benign(P<0.001).Using a cutoff value of ES>2 as indicator of malignancy,sensitivity,specificity,PPV,NPV,accuracy was 92.5%,80.6%,91.2%,83.3%and 88.8%,respectively,whereas those were 80.6%,93.5%,96.4%,69.0%and 84.7%for SR>2.7.The area under the curve(AUC)value of ES,SR and conventional ultrasonography in the diagnosis of malignant thyroid nodules was 0.866,0.871 and 0.723,respectively.The AUCs of ES and SR were significantly greater than that of conventional ultrasound(P<0.05),and there was no significant difference in AUCs between ES and SR(P>0.05).Conclusion:RTE has high diagnostic value and can provide evidence for the differentiation of thyroid nodules.Part 2:The Correlation between Elasticity Score,Strain Ratio of Real-time Elastography and Microvessel Density in Papillary Thyroid CarcinomaObjective:To investigate the correlation between elasticity score(ES),strain ratio(SR)of real-time elastography(RTE)and microvessel density(MVD)in papillary thyroid carcinoma(PTC).Methods:Between January 2016 and December 2017,a total of 54 patients with 58 PTC nodules confirmed by pathology after surgery in our hospital was enrolled in this study..All patients underwent conventional ultrasound and RTE examination preoperatively.CD34 immunohistochemical staining and MVD count were performed postoperatively.The nodules were divided into ?10mm group(35 cases),10-20mm group(15 cases)and>20mm group(8 cases)according to the maximum diameter of the nodules in gray scale ultrasonography.The difference of ES,SR and MVD in the three groups was compared,and the correlation between ES and MVD,SR and MVD in PTC nodules was assessed.Result:ES>2 and SR>2.7 were found in the most PTC nodules(account for 93.1%and 77.6%,respectively).There were no significant difference in both ES and SR among the ?10mm,10?20mm and>20mm groups(P>0.05).The mean MVD of the three groups was 47.7±8.8,51.1±8.5 and 56.1±5.8,respectively.Significant differences of MVD was revealed among the three groups(P<0.05).The MVD of ES 2,3 and 4 was 55.6±9.5,53.3±7.7 and 43.9±6.7,respectively.There was significant difference in MVD among different scores(P<0.001).Both ES and SR were significantly negative correlation with MVD in PTC nodules(r=-0.567,P<0.001;r=-0.570,P<0.001).Conclusion:RTE has potential clinical value in predicting aggressiveness and prognosis of PTC preoperatively.Part 3:The Relationship Between Elasticity Score,Strain Ratio of Real-time Elastography and Cervical Lymph Node Metastasis in Papillary Thyroid CarcinomaObjective:To explore the relationship between elasticity score(ES),strain ratio(SR)of real-time elastography(RTE)and cervical lymph node metastasis in papillary thyroid carcinoma(PTC).Methods:Fifty-four patients with 58 PTC nodules proven by pathology in our hospital from January 2016 to December 2017 were enrolled in this study.All patients underwent conventional ultrasound and RTE examination preoperatively.The ES and SR of each PTC nodule were acquired according to a standard protocol.Based on the pathological findings,the nodules were divided into cervical lymph node metastasis group(29 cases)and non-cervical lymph node metastasis group(29 cases).The correlation between the ES,SR and the status of lymph node metastasis of PTC was analyzed.The receiver operating characteristic(ROC)curves of ES and SR were plotted to determine the optimal cutoff value for predicting lymphatic metastasis of PTC.Result:The majority of nodules was ES 3(72.4%)and the mean SR was 2.9±1.1 in metastasis group,whereas ES 4 was mainly in non-metastasis group(62.1%)with a mean SR of 4.4 ± 1.1.The ES and SR of the metastatic group was significant lower than that no metastasis(P<0.01).There were significantly negative correlations between ES,SR and lymph node metastasis in PTC nodules(r=-0.449,P=0.000;r=-0.547,,P=0.000).The AUC value of ES and SR in predicting lymph node metastasis was 0.729 and 0.816,respectively.With ES?3 as a cutoff value,sensitivity and specificity were 82.8%and 62.1%,respectively.Meanwhile,SR?3.85 showed a 82.8%sensitivity and 72.4%specificity.Conclusion:RTE is useful to predict the lymphatic involvement of PTC,and seems to be helpful for clinical strategy determining. |
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