| Objective:Discussion the diagnostic value of ultrasound-guided fine-needle aspiration(US-FNA)combined with contrast enhanced ultrasound(CEUS)in thyroid nodules.Analyze the effect of related ultrasonographic characteristics of thyroid nodules on US-FNA results.Methods:A total of 251 nodules of 235 patients with thyroid nodules who were treated in our hospital from October 2015 to November 2017 and made US-FNA.According to Bethesda System of Cytopathology,analysis ultrasound image features:(size,depth,Calcification type,calcification ratio,solid ratio),and analyze the relationship between the above characteristics and US-FNA results.Retrospective analysis of US-FNA and CEUS data of 163 patients with 173 thyroid nodules confirmed by surgical pathology and follow-up.Bethesda ? ? was used as the malignant diagnostic criteria in US-FNA.Uniform low enhancement,non-uniform low enhancement,early low enhancement are considered as diagnostic criteria for CEUS.To compare and analyze the value of US-FNA,CEUS and the combination of both in diagnosis of thyroid nodules.Results:1.The diagnostic value of US-FNA combined with CEUS in thyroid nodules: The sensitivity,specificity,accuracy,positive predictive value and negative predictive valueof US-FNA,CEUS and their combination were(80.2%,80.2%,93.7%),(100%,93.5%,93.5%),(89.0%,86.1%,93.6%),(100%,93.9%,94.7%)and(80.2%,79.1%,92.3%).The sensitivity and accuracy of US-FNA combined with CEUS were the highest in the diagnosis of thyroid nodules.Compared with the application of US-FNA alone and CEUS alone,the difference was statistically significant(P<0.05).2.Related ultrasonographic characteristics on US-FNA results of thyroid nodules:(1)Size: The inefficiencies of the US-FNA results in group A1(0.5cm?d<1cm),B1(1cm?d<1.5cm),C1(1.5cm?d<2cm)and D1(d?2cm)respectively were 42.4%(36/85),19.4%(12/62),15.2%(5/33)and 15.5%(11/71),the overall difference was statistically significant(P<0.05).The difference between group A1 and B1,A1 and C1,A1 and D1 was statistically significant.There was no significant difference between the other groups.(2)Depth: The inefficiencies of US-FNA in group A2(shallow),B2(middle),C2(deep)respectively were 23.2%(23/99),16.7%(15/90)and 41.9%(26/62),The overall difference was statistically significant(P < 0.05).There were significant differences between group C2 and A2,C2 and B2.The difference between the group A2 and B2 was no significant.(3)Calcification type: The inefficiencies of US-FNA in group A3(no calcification),B3(micro-calcification),C3(coarse calcification)respectively were 22.5%(20/89),15.9%(17/107)and 49.1%(27/55),the overall difference was statistically significant(P<0.05).The difference between group C3 and A3,C3 and B3 was statistically significant.There was no significant difference between the groupA3 and B3.(4)Calcification ratio: The inefficiencies of US-FNA in group A4(C-R=0%),B4(0%<C-R?25%),C4(25%<C-R?50%),D4(50%<C-R?75%),E4(75%<C-R)respectively were 22.5%(20/89),15.4%(12/78),16.7%(9/54),75.0%(15/20)and 80.0%(8/10),the overall difference was statistically significant(P<0.05).The D4 group and E4 group were respectively compared with the A4 group,the B4 group,and the C4 group,The difference was statistically significant.There was no significant difference between the other groups.(5)Solid ratio: The inefficiencies of US-FNA in group A5(0%<S-R?25%),B5(25%<S-R?50%),C5(50%<S-R?75%),D5(75%<S-R?100%)respectively were83.3%(5/6),80.0%(4/5),21.9%(9/41)and 23.1%(46/199),the overall difference was statistically significant(P < 0.05).The A5 group and B5 group were respectively compared with C5 group and D5 group,the difference was statistically significant.There was no significant difference between the other groups.Conclusion:1.The combination of US-FNA and CEUS can improve the sensitivity and accuracy of thyroid nodule diagnosis.2.When the maximum diameter of thyroid nodules is 0.5cm?d<1.0cm,location in the deep,coarse calcification,calcification ratio C-R>50%,and the solid ratio S-R?50%,Inefficiency of US-FNA results will increase. |
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