Diagnostic Value Of Ultrasound For Thyroid Cancer And Its Correlation With TCM Syndromes

Diagnostic value of ultrasound for thyroid cancerObjective:To analyze the clinical value of ultrasound features in the diagnosis of thyroid cancer,and to compare the diagnostic efficacy of the American Thyroid Society(ATA)sonographic pattern,the Thyroid Imaging Report and Data System(TI-RADS)proposed by American College of Radiology in 2017 and elastography,as well as the clinical value of TI-RADS combined with elastography in the differential diagnosis of thyroid nodules.Methods:From January 2012 to May 2018,644 patients with 865 thyroid nodules underwent preoperatively thyroid ultrasonographic examination and thyroidectomy.General information on clinical features,Gray-scale ultrasonography of the thyroid,ultrasound elastography and postoperative histopathology were collected.All thyroid nodules were graded by ATA sonographic pattern,Tl-TADS,elastography grading and scoring methods.Meanwhile,two methods in various combination were conducted as follows:method 1,elastography scores and the grades of TI-RADS are added;method 2,elastography scores and TI-RADS scores are added together for a new grading system.The postoperative histopathology was regarded as a gold standard to construct the receiver work curve,calculate the area under the curve(AUC),and the best diagnostic cut points were selected according to the Yoden index to compare their diagnostic efficacy.Results:Suspicious ultrasound features such as solidity,hypoechogenicity,irregular margin,taller-than-wide shape,and microcalcification were significantly associated with thyroid cancer.The AUC of each ultrasound feature was less than 0.5(P<0.001).As the grades of the various diagnostic methods increased,the malignant rate of thyroid nodules gradually increased.Of all nodules,17.45%(151/865)did not meet the ATA pattern criteria,with a malignant risk of 59.60%(90/151).The ATA sonographic pattern had higher sensitivity(95.96%vs.75.19%vs.80.72%,P<0.001)and negative predictive value(NPV)(80.290 vs.50.30%vs.56.86%)than TI-RADS and elastography,but the specificity was lower(56.12%vs.85.71%vs.86.73%,P<0.001).The area under curve(AUC)of the TI-RADS was not statistically different from the elastography but higher than the ATA sonographic pattern(0.860 vs.0.647,P<0.001).There was no statistical difference between the AUC of method 1 and method 2(0.907 vs.0.918).Conclusion:Some ultrasound features are associated with risk of malignancy in thyroid nodule,however,their diagnostic value is limited.The ATA sonographic pattern provides relatively higher sensitivity and NPV.TI-RADS and elastography have favorable diagnostic performance and are superior to the ATA sonographic pattern.The performance of method 1 or 2 is superior to any one of TI-RADS and elastography.The grade 4 of method 2 has a higher discriminatory value in the differentiation of benign and malignant thyroid nodules.Correlation of ultrasound features and reporting systems with TCM syndromes of patients with thyroid cancerObjective:To explore the correlation of ultrasound features,reporting systems,clinical data with TCM syndrome types in patients with thyroid cancer,and to compare their distribution patterns among various syndrome types,so as to provide objective indicators for clinical differentiation of thyroid cancer.Methods:From April 2019 to December 2019,293 patients who underwent surgical treatment were selected.General information of patients,thyroid function,ultrasonic features,elastography scores and TCM syndrome types were collected.Univariate analysis was used to screen out the variables related to each syndrome type,and then binary logistic regression analysis was used to obtain independent factors for each syndrome type.Results:The distribution of TCM syndromes in patients with thyroid cancer was found that phlegm and blood stasis syndrome,liver-qi stagnation syndrome,phlegm and dampness coagulation syndrome,and yin deficiency and internal heat syndrome accounted for 34.81%,27.99%,26.62%,10.58%,respectively.Phlegm and blood stasis syndrome was significantly correlated with the absence of Hashimoto's thyroiditis(P=0.018),the absence of subelinical hyperthyroidism(P?0.008),maximum tumor diameter(P<0.001),malignant ultrasound features other than components,and ultrasound reporting systems.The independent risk factors were the absence of subclinical hyperthyroidism(OR=15.625,P=0.037),the absence of Hashimoto's thyroiditis(OR=5.347,P=0.002),tumor maximum diameter>lcm(OR=2.958,P=0.003),microcalcification(relative to none echogenic foci,OR=23.105,P<0.001),taller-than-wide shape(OR=3.233,P<0.001),very/hypoechoic(OR=7.250,P=0.001;OR=5.749,P<0.001).Liver-qi stagnation syndrome was associated with the presence of subclinical hyperthyroidism(P=0.026),the presence of Hashimoto's thyroiditis(P=0.001),the maximum tumor diameter(P<0.001),echogenicity(P<0.001),echogenic foci(P<0.001),the elastography scores(P<0.001)and combined grades(P<0.001).Among them,independent risk factors were the presence of Hashimoto's thyroiditis(OR=3.106,P=0.006),tumor maximum diameter?1cm(0R=4.208,P<0.001),macrocalcification(compared with none echogenic foci,OR=8.943,P<0.001),mixed cystic and solid(compared with hypoechoic,OR=6.173,P<0.001:compared with very hypoechoic,OR?16.949,P=0.001),elastography score of 2 points(compared with 3 points,OR=2.785,P=0.037;compared with 4 points,OR=3.175,P=0.024).Phlegm-dampness coagulation syndrome was related to the absence of subclinical hyperthyroidism(P=0.049),overweight(P=0.042),shape(P=0.001),echogenic foci(P<0.001),elassification of the Thyroid Imaging Report and Data System(TI-RADS)proposed by American College of Radiology in 2017(P?0.005).The independent risk factors were the absence of subclinical hyperthyroidism(OR=9.524,P=0.036),none echogenic foci(contrast macrocalcification,OR?16.129,P<0.001;contrast punctate echogenic foci,OR=5.780,P<0.001),wider-than-tall shape(OR=2.404,P<0.001).Yin deficiency and internal heat syndrome was related to the presence of subclinical hyperthyroidism(P=0.005),echogenic foci(P?0.012),and elastography scores(P=0.047).The independent risk factors included the presence of subclinical hyperthyroidism(OR?6.325,P=0.001),none echogenic foci(compared with macrocalcification,OR=3.731,P?0.032;compared with microcalcification,OR=4.762,P?0.002),elastography score of 3 points(compared with 2 points,OR?5.293,P=0.014).Conclusion:The preoperative syndrome types of patients with thyroid cancer is mainly phlegm and blood stasis syndrome,followed by liver-qi stagnation syndrome,phlegm dampness coagulation syndrome,yin deficiency and internal heat syndrome is relatively few.The absence of Hashimoto's thyroiditis,the absence of subclinical hyperthyroidism,tumor maximum diameter>lem,microcalcification,taller-than-wide shape,very/hypoechoic can be used as dialectical reference indicators for phlegm and blood stasis syndrome;the presence of Hashimoto's thyroiditis,tumor maximum diameter?1cm,macrocalcification,mixed cystic and solid,elastography score of 2 points can be used as a dialectical reference indicators for liver-qi stagnation syndrome;the absence of subclinical hyperthyroidism,none echogenic foci,wider-than-tall shape be used as a dialectical reference indicators for phlegm-dampness coagulation syndrome;the presence of subclinical hyperthyroidism,none echogenic foci,elastography score of 3 points can be used as dialectical reference indicators for yin deficiency and internal heat syndrome.