Diagnostic Value Of Contrast-enhanced Ultrasound Combined With Ultrasound-guided Fine Needle Aspiration For TI-RADS4a Thyroid Nodules

Objective:To evaluate the diagnostic value of contrast enhanced ultrasound(CEUS)combined with ultrasound-guided fine-needle aspiration(US-FNA)in differentiating malignant and benign thyroid nodules.Methods:the clinic were collected in our hospital from January 2018 to January 2020 surgical pathology confirmed 126 cases of thyroid nodule TI-RADS4 a class a total of 141 patients with nodule preoperative data for US-FNA and CEUS surgery pathological results were retrospectively analyzed,including,CEUS in the diagnosis of malignant nodules low standard for homogeneous enhancement,early low,uneven enhancement,US-FNA in Bethesda system of IV judging malignant nodules or standard.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the diagnosis of TI-RADS4 a thyroid nodules by CEUS,US-FNA and CEUS combined with US-FNA were calculated and compared.Taking postoperative pathological diagnosis results as the gold standard,Kappa consistencytest was used to evaluate the consistency between the diagnosis results of the three methods and the postoperative pathological diagnosis results.0.75 > Kappa?0.4 means the consistency of the two is general;Kappa <0.4 indicates poor consistency between the two,and P < 0.01 indicates statistically significant difference.Results:the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of US-FNA in diagnosing TI-RADS4 a thyroid nodules were 81%,86%,83%,89.5% and 75.4%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CEUS in diagnosing TI-RADS4 a thyroid nodules were 81%,57.9%,71.6%,73.9% and 67.5%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CEUS and US-FNA in the diagnosis of TI-RADS4 a thyroid nodules were 90.5%,54.4%,75.9%,74.5%and 79.5%respectively.The combination of CEUS and US-FNA in the diagnosis of TI-RADS4 a thyroid nodule has a high sensitivity,while US-FNA has the highest specificity.According to the gold standard of postoperative pathological diagnosis,Kappa consistency test was conducted between CEUS results and postoperative pathological results,Kappa =0.397(Kappa < 0.4),with poor consistency and statistically significant(P < 0.01).The Kappa value of US-FNA was 0.654(0.75 > Kappa?0.4),with a general consistency and statistically significant(P < 0.01).The kappa value of the combinedresults was 0.473(0.75 > kappa ?0.4),indicating a general consistency and statistically significant(P < 0.01).Conclusion:There was no difference in the sensitivity of US-FNA and CEUS.The combined sensitivity of the two was higher than that of CEUS and US-FNA,which could improve the sensitivity of differential diagnosis of TI-RADS4 a thyroid nodules without significantly improving the accuracy and specificity of the diagnosis.