The Value Of Different Examination Methods In Qualitative Thyroid Nodules

Objective:The prevalence of thyroid nodules has been as high as 20%to 79%,of which 7%～15%are malignant[1].At present,there are many diagnostic methods for thyroid nodules.It is of great importance to find a simple examination method with less trauma and economic burden to accurately evaluate the nature of thyroid nodules in detecting malignant thyroid nodules in the early stage.Several examination methods for qualitative thyroid nodules are compared in order to find better examination methods for accurate evaluation of qualitative thyroid nodules and reduce unnecessary operation in order to save medical resources and reduce the burden of patients.Methods:A total of 243 patients with single or multiple thyroid nodules were enrolled in the receive treatment in Chengdu First People’s Hospital from March 2015 to October 2020,including 79 males and 164 females,with a total of 344 nodules.All the subjects underwent thyroid routine ultrasound,ultrasound-guided fine needle aspiration biopsy(US-FNAB)smear cytological and thinprep cytologic test(TCT),surgical pathological results.A total of 98 nodules in 89 patients underwent contrast-enhanced ultrasonography(CEUS)and real-time elastography(RTE).Conventional ultrasound was classified as TR4 or more according to ACR TI-RADS classification,and real-time ultrasound elastography was judged as malignant nodule according to Rago5 elastic score≥4.In addition,puncture cytology was based on Bethesda classification report system,and the results were compared with the results of operation and pathology.Observe the value of thyroid ultrasound,US-FNAB smear,TCT and the combination of the two or more methods in the qualitative diagnosis of thyroid nodules.Results:1.Among the 243 subjects,there were 134 cases of malignant nodules and 79 cases of benign nodules,and the ratio of male to female thyroid cancer was 1:2.49.The total number of nodules is 344,of which 138 and 206 are benign and malignant nodules respectively.Benign nodules were mainly nodular goiter,accounting for 58.0%;malignant nodules were mainly papillary thyroid carcinoma(PTC),accounting for 97.1%,about 19.0%of PTC patients have Hashimoto’s thyroiditis(HT).The average age of malignant nodules(44.49±15.36 years)was lower than that of benign nodules(52±11.36 years),and the difference was statistically significant(P<0.05).2.The total number of nodules was 344,routine ultrasound diagnosis is divided into 5 categories according to ACR TI-RADS,which are TR1,TR2,TR3,TR4,and TR5.Compared with the malignant rate is 0,3.7%,29.5%,87.2%,and 100%.3.Compared with thyroid nodule pathology in 243 patients with thyroid nodules,the sensitivity(Se),specificity(Sp),accuracy(DOA),positive predictive value(PPV),and negative predictive value(NPV)of ultrasound diagnosis were 86.4%,82.6%,84.9%,88.1%,and 80.3%,respectively.The US-FNAB traditional smears were 87.2%,97.5%,90.5%,98.6%,78.6%,respectively.TCT was 46.3%,97.5%,63.0%,97.4%,46.7%,respectively.US-FNAB traditional smear combined with TCT was 93.3%,98.7%,95.1%,99.4%,87.6%,respectively.The Se,DOA and NPV of US-FNAB traditional smear and US-FNAB traditional smear combined with TCT were significantly higher than TCT,and the difference was statistically significant(P<0.05).The sensitivity,accuracy and negative predictive value of US-FNAB traditional smear combined with TCT were slightly higher than US-FNAB traditional smear,and the difference was not statistically significant.4.Compared with thyroid nodule pathology of 98 thyroid nodules in 89 patients with thyroid nodules,the Se,Sp,DOA,PPV,and NPV of RTE was 52.0%,88.2%,44.4%,94.7%,and 25.0%,respectively.CEUS was 83.8%,64.7%,87.7%,92.2%,and 52.4%,respectively.CEUS combined RTE were 88.9%,98.6%,89.8%,98.2%,and 65.4%,respectively.The Se,DOA and NPV of CEUS,CEUS combined with RTE were significantly higher than RTE,and the difference was statistically significant.Compared with CEUS,CEUS combined with RTE had no statistically significant differences in Se,Sp,DOA,PPV,and NPV.5.Compared with thyroid nodule pathology of 98 thyroid nodules in 89 patients with thyroid nodules,the Se,Sp,DOA,PPV,and NPV of ultrasound diagnosis were 86.4%,41.2%,78.6%,87.5%,and 38.9%,respectively.Ultrasound combined with CEUS was 88.9%,94.1%,89.8%,98.6%,and 64.0%,respectively.The Se,DOA and NPV of CEUS,CEUS combined with RTE were significantly higher than RTE,and the difference was statistically significant.The Se,Sp,DOA,PPV,and NPV of CEUS combined with RTE were slightly higher than CEUS,and the difference was not statistically significant.The Sp and PPV of ultrasound combined with CEUS were higher than ultrasound,and the difference was statistically significant.The Sp of ultrasound combined with CEUS is better than CEUS,and the difference is statistically significant.6.Compared with thyroid nodule pathology of 98 thyroid nodules in 89 patients with thyroid nodules,the Se,Sp,DOA,PPV,and NPV of CEUS combined with US-FNAB traditional smear were 98.7%,97.9%,98.9%,98.9%,94.4%,respectively.The Se,Sp,DOA,PPV,and NPV of RTE,CEUS,US-FNAB traditional smears and TCT were 98.7%,97.9%,98.9%,98.9%,and 98.9%,respectively.CEUS combined with US-FNAB traditional smear and the combination of the four examination methods are higher than the single use of any one of the examination methods,and the difference is statistically significant.However,CEUS combined with US-FNAB traditional smear is not compared with the combination of the four examination methods statistical difference.Conclusion:1.Ultrasonic diagnosis has great significance in the diagnosis of primary screening thyroid nodules.2.CEUS is superior to RTE in qualitative thyroid nodules benign and malignant.CEUS combined RTE fails to significantly increase the detection rate compared with CEUS.3.US-FNAB traditional smear is better than TCT.US-FNAB traditional smear combined with TCT fails to improve the detection rate compared to US-FNAB traditional smear.4.Ultrasound and US-FNAB traditional smear cytology have high accuracy in assessing benign and malignant thyroid nodules.CEUS can improve the accuracy of detection to a certain extent.When thyroid nodules are suspected of being malignant thyroid nodules after primary ultrasound screening,CEUS combined with US-FNAB traditional smear can be used as a preoperative examination for suspected malignant thyroid nodules with high accuracy.