The Value Of TI-RADS Classification And Contrast-enhanced Ultrasonography In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective The application of TI-RADS classification in thyroid nodules is becoming more and more widely used in clinical practice.This article will explore its value from the perspective of consistency between different observers and its diagnostic accuracy.And the combined use of TI-RADS classification and CEUS improves the differential value of benign and malignant thyroid nodules.To compare the pathological results,analyze the differences of CEUS different features in benign and malignant thyroid nodules.Methods A thyroid nodule patient who was seen at the Department of Ultrasound in the Affiliated Hospital of Yan'an University from October 2015 to December 2017 was selected.The CEUS was performed on routine sonographic examination of suspicious or difficult-to-identify nodules.Four physicians performed a retrospective analysis of the routine and angiographic features of the lesions and classified the risks.The TI-RADS classification uses the TI-RADS taxonomy of Ruijin Hospital's 2015 integration method.Consistency analysis was performed on the results,including the consistency of TI-RADS descriptors among different observers and the consistency of TI-RADS classification results.Kappa consistency analysis was used.After the classification of TI-RADS based on descriptive words,the diagnosis accuracy rate was evaluated,including the comparison of the accuracy of TI-RADS classification with traditional ultrasound diagnosis,the comparison of TI-RADS predicted malignant rate,and the accuracy of post-co-CEUS diagnosis.The ROC curve was used to analyze the accuracy of diagnosis,and the Sensitivity(Sen),Specificity(Spe)and Youden's index of different diagnostic methods were compared according to the best diagnostic points selected by the ROC curve.The difference uses the z test of the evaluation index.The CEUS enhancement model uses chi-square test to differentiate between benign and malignant thyroid nodules.P<0.05,the difference was statistically significant.Results Included 91 thyroid nodules.There were 48 malignant nodules and 43 benign nodules.The mean age was(42±10.8)years in the benign group and(46±11.4)years in the malignant group.For the consistency analysis,the different seniority physicians observed TI-RADS descriptive words microcalcification,A/T> 1,internal blood flow,hypoechoic,blurred boundary,non-abrasive,and solid Kappa values were(0.783,0.778,0.682,0.577,0.545,0.401,0.263);The same seniority physicians observed TI-RADS descriptors A/T>1,microcalcification,internal blood flow,hypoechoic,marginal borderline,blurred boundary,solid Kappa values were(0.802,0.759,0.685,0.516,0.468,0.435,-0.015).The Kappa values of TI-RADS classification between different seniority physicians and between same seniority physicians were(0.519,0.568).For the diagnostic accuracy analysis,the area under the ROC curve of the TI-RADS classification was 0.790.The best diagnostic boundary was TI-RADS category 5(Sen = 58.3%,Spe = 88.4%,Youden's index = 0.467).The area under the ROC curve of traditional ultrasound diagnosis was 0.819,and the best diagnosis threshold was ? 4b(Sen = 79.2%,Spe = 72.1%,Youden's index = 0.513).The area under the ROC curve of TI-RADS combined with CEUS was 0.905.The best diagnostic cut-off point was ? 4c(Sen = 81.3%,Spe = 88.4%,Youden's index = 0.687).In this group of patients,CEUS enhancement features were compared with pathological findings.The distribution uniformity,enhancement degree,boundary,direction of enhancement,and perfusion time were statistically significant between benign and malignant thyroid nodules.Conclusion1.The consistency of TI-RADS descriptors between different observers is medium and above.Only the "edge" and "boundary" are relatively weak.The TI-RADS classification results are moderately consistent across different observers.The stability of each observation index and result was not affected by the experience of the doctor.2.The accuracy of TI-RADS classification diagnosis is lower than traditional ultrasound diagnosis in this group of data,but the difference is not statistically significant.The Sen of TI-RADS classification at the best diagnostic site is lower than traditional ultrasound.3.The malignant percentage of TI-RADS classification 4A,4C,and 5 is lower than its predicted malignant rate,which indicates that TI-RADS has a high evaluation score for some thyroid nodules.4.TI-RADS classification combined with CEUS can significantly improve the accuracy of diagnosis.5.CEUS different enhancement modes have very important clinical value in differentiating benign and malignant thyroid nodules.