| BackgroundThe incidence of thyroid cancer has reached the first place in head and neck malignant tumors.As the preferred technology,the ultrasonic diagnosis after the introduction of thyroid imaging reporting and data system is more accurate and standardized,but there are still defects: low diagnostic efficacy;Diagnostic uncertainty;Different weights of diagnostic signs;Moreover,important information such as lesion hardness and internal microcirculation is lacking.The emergence of ultrasound elastography and contrast ultrasound can make up for these deficiencies.In this study,a variety of ultrasonic imaging techniques were applied to improve the rate of thyroid cancer diagnosis.ObjectiveAnalysis of the weight of each malignant sign in TI-RADS classification.The combined application of multiple ultrasound imaging diagnostic methods can correct the insufficiency of TI-RADS classification,improve the diagnosis rate of thyroid cancer risk assessment,and reduce the traumatic examination and over treatment caused by misdiagnosis.MethodA total of 266 nodules were selected from 253 patients with thyroid nodules who underwent surgery or fine-needle aspiration in our hospital from January 2015 to December 2017,including 42 males and 211 females,aged 13-86 years old,with an average age of 49.8±13.5years.An ultrasonic retrospective evaluation of thyroid nodules,adopting Kwak TI-RADS ultrasonic manifestations of classified dictionary recorded acoustic image characteristics of thyroid nodules,including thyroid backgr-ound echo,number of lesions,size,internal echo,edge,aspect ratio and calcification,acoustic halo,distance from the capsule,the blood flow characteristics and the far-f ield echo attenuation,etc.From these cases,122 TI-RADS thyroid nodules with type3 or more were selected,which were confirmed by surgery and pathology,excluded the large calcified nodules and examined by ultrasound elastography(UE)and cont-rast enhanced ultrasound(CEUS).On the basis of the TI-RADS classification standa-rd of Kwak edition,these selected nodules were classified according to the five m-ajor malignant signs of nodular solid components,low or very low echo,lobulated or irregular edges,aspect ratio ?1,microcalcification:Type 1,Normal thyroid gland;type 2,Benign nodules;type 3,Benign nodules were more likely;type 4,Suspicious malignant nodules,according to the malignant signs of ultrasound,it could be subdivided into four categories: 4A(1 malignant sign),4B(2 malignant signs),4C(3-4 malignant signs),5 categories(5 malignant signs),malignant nodules were highly likely.Categories 3 and 4A of TI-RADS classification were classified as ben ign nodules,and categories 4B,4C and 5 were classified as malignant nodules.The elastic images were required to maintain a pressure release index of 3-4,which co-uld clearly reflect the rigidity of the tissues at all levels and last for 3-4 seconds.1-3 were benign and 4-5 were malignant.The contrast-enhanced ultrasound pattern was initiated by selecting the largest thyroid nodule plane,and the thyroid nodule enhancement was classified as malignant nodules,while the ring enhancement,unifo-rm enhancement and no enhancement were classified as benign nodules.To evaluate the sensitivity,specificity and accuracy of the above diagnostic methods with the surgical pathological results as the diagnostic gold standard,the elastic images were scored and the enhancement patterns were analyzed,and the benign and malignant nodules were judged.Combined use of multiple diagnostic ultrasound techniques:Evaluation of thyroid nodules based on characteristics that were accord with two or more ultrasound diagnoses,that is,there were two or more methods to suggest that the benign nodules,the diagnosis of Benign Nodules;If two or more methods suggest malignancy,the nodule was diagnosed as malignant.In addition,the nodules without enhancement were directly classified as benign.ResultThe main signs of benign thyroid nodules were oval shape,aspect ratio<1,clear margin and regular shape.The main signs of thyroid malignant nodules were solid,hypoechoic,microcalcification,unclear margin,irregular shape,aspect ratio?1,Far-f ield attenuation and capsule invasion.1.The diameter of thyroid malignant nodules was significantly smaller than th at of benign nodules(p=0.0059),but there were no significant differences in sex,age,background and number of thyroid malignant nodules(p>0.05).2.The main signs of malignant thyroid nodules are solid,hypoechoic,microca-lcification,unclear margin,irregular shape,aspect ratio?1,Far-field attenuation and invasion of the capsule,and there were differences compared with benign nodules(p<0.05),but no significant differences between benign and malignant nodules(p>0.05)in the uniformity of nodule texture,location of blood flow,richness and presence or absence of Halo.3.Among the signs of thyroid malignant nodules,the highest sensitivity was solidity(100.00%),followed by low echo(87.80%),and the higher specificity were capsule invasion(95.11%),aspect ratio?1(94.22%)and far-field Echo attenuation(90.22%),The Order of higher accuracy was the aspect ratio?1(88.72%),the film invaded(85.71%),far-field Echo attenuation(83.83%),irregular morphology(83.46%)and mic-rocalcification(83.08%).4.The sensitivity,specificity and accuracy of simple application of TI-RADS classification to diagnose benign and malignant nodules were 68.3%,58% and 61.5%respectively.The sensitivity,specificity and accuracy of combined TI-RADS classification,UE and CEUS were 90.2%,96.3% and 94.3% respectively,and there was a significant difference between the two groups(p<0.05).Conclusion1.The malignant signs of thyroid nodule include solid,hypoechoic,microcalcification,unclear margin,irregular shape,aspect ratio?1,far field attenuation and invasion of the capsule.2.The combined application of TI-RADS classification,UE and CEUS technique is of significantly improved efficacy and high clinical value in the diagnosis of thyroid nodule. |
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