| Objective To evaluate preoperative ultrasound thyroid imaging reporting and data system(TI-RADS)and serum Thyroid function in diagnosis papillary thyroid carcinoma combined with Hashimoto's thyroiditis.Methods Eighty patients admitted to the Affiliated Hospital of North China University of Technology from July 2012 to July 2017 were selected as the study subjects.Forty patients with papillary thyroid cancer and Hashimoto's thyroiditis were in HT group and40 patients with simple papillary thyroid cancer were in non-HT group.All patients underwent thyroidectomy with a definite pathological diagnosis.The medical data in the two groups,included age,sex,the number of cancer nodules in TI-RADS classification,the feather of preoperative ultrasound TI-RADS,and the value of serum Thyroid stimulating hormone(TSH),Triiodothyronine(TT3),Thyroxine(TT4),FreeTriiodothyronine(FT3),Free Thyroxine(FT4),anti-Thyroglobulin antibody(TgAb),anti-Thyroid peroxidase antibody(TPOAb),were analyzed.The sensitivity,specificity and kappa values of the factors with statistical significance were calculated to understand the clinical application value.Result There were 94 cancerous nodules,49 in HT group,45 in no-HT group.There were no statistically significant difference between groups in gender,5 males 35 females in HT group and 7 males 33 females in no-HT group(p=0.531,shown in table 1).Based on the WHO definition of youth and elderly,?44or>44,14 and 26 in HT group,12 and 28 in no-HT group,there was no difference,too(p=0.663,shown in table 2).According to ultrasound TI-RADS(grade 1,2,3,4a,4b,4c,and grade 5),the number of cancer nodules was0,0,1,15,21,10,2 in HT group,and 0,0,1,17,19,7,1 in no-HT group,no statistically difference was detected(p=0.901,shown in table3).Compared cancerous feature of thyroid ultrasound between groups,including solid nodules,hypoechoic or hypoechoic,irregular boundaries,microcalcifications,and aspect ratio>1,only the amount of microcalcifications in HT group was bigger than that in no-HT group(p=0.005),no significant was statistical in hypoechoic or hypoechoic(p=0.536),solid nodules(p=0.877),irregular boundaries(p=0.323),aspect ratio>1(p=0.474),details were shown in table 4.The concentration of serum TSH was divided into 5 levels,level1(<0.27 uIU/ml),level 2(0.27~1.58uIU/ml),level 3(1.59~2.88uIU/ml),level 4(2.89~4.20uIU/ml)and level 5(>4.20uIU/ml).With the level increased,the ratio of cases in HT group also increased(p=0.047,shown in table 5).In HT group,the cases with positive TgAb were 17,positive TPOAb were 8,positive TgAb and positive TPOAb were 5,negative TgAb and negative TPOA were 10,correspondingly,in no-HT group the case was6,7,5,and22,the statistical difference between groups was detected(p=0.020,shown in table 6).About the parameter of Thyroid function,no difference was detected betweengroups,FT3(t=1.587,p=0.112),FT4(t=0.245,p=0.656),TT3(t=0.844,p=0.386),TT4(t=0.578,p=0.566).The sensitivity,specificity and Kappa value were 44.90%,82.22% and0.267 for the diagnosis of PTC combined with HT by microcalcification,which showed that the missed diagnosis rate of microcalcification was too high and the consistency with pathological diagnosis was very low.The ROC curve analysis of TSH diagnosing PTC with HT shows that the area under the curve is 0.737,which shows that TSH has certain diagnostic ability for PTC with HT.See Fig.3 and Table 9.According to ROC curve,the critical value of TSH is 3.52uIU/ml.See Table 10.The diagnostic tests of HT group and non-HT group were performed with TSH(>3.52uIU/ml).The diagnostic results were shown in Table 11.The results showed that the sensitivity,specificity and Kappa value of TSH in the diagnosis of PTC with HT were 72.5%,75.0% and 0.475 respectively(p<0.000),indicating that the diagnostic results of TSH were moderately consistent with those of pathological diagnosis.The sensitivity,specificity and Kappa value of 75.0%,55.0% and 0.300 for autoantibody positive diagnosis of PTC with HT are shown in Table12.The results showed that the clinical missed diagnosis rate and misdiagnosis rate of PTC with HT were higher,and the consistency with pathological diagnosis was lower.Conclusion 1 Microcalcification and TgAb,TPOAb positive diagnosis of papillary thyroid cancer with Hashimoto's thyroiditis,poor consistency with pathological diagnosis,does not have clinical value;2 Serum TSH in the diagnosis of papillary thyroid cancer with Hashimoto's thyroiditis is moderately consistent with pathological diagnosis,and has certain diagnostic value,but its clinical value is limited.Figures 5;Tables 12;References 110. |
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