Clinical Multi-Factor Analysis Of Preoperative Judgment Of Thyroid Nodule Of Bethesda Ⅴ

ObjectiveBy analyzing the clinical data of patients with FNA guided by ultrasound,to explore the reasons for the difference between Bethesda Ⅴ nodules and Bethesda Ⅵ thyroid nodules,so as to improve the diagnostic accuracy of Bethesda Ⅴ nodules and provide a more powerful basis for preoperative screening and accurate treatment of thyroid carcinoma.MethodsThe clinical data of 430 patients with fine needle puncture（FNA）of thyroid nodules treated by ultrasound were retrospectively analyzed.the following clinical data were statistically analyzed:sex composition,age,BMI,preoperative TG、TP0Ab titer,presence or absence of Hashimoto,ultrasound-related indicators:preoperative TIRADS grading,location,shape,multifocality,echogenicity,aspect ratio,boundary,calcification or not,relationship with the membrane,blood flow,tumor length,tumor histological type,presence or absence of membrane invasion.The statistical analysis of counting data adopts χ² test or Fisher for accurate testing and the measurement data adopts t test.Single factor and multivariate analysis using binary Logistic regression analysis.RESULTSIn this study,the incidence of,Bethesda Ⅴ nodules pathologically proved to be benign nodules was 12.6%（20 amp 179）.Among Bethesda Ⅴ nodules,the results of univariate analysis showed that the benign and malignant nodules of Bethesda Ⅴ were not related to age,sex,BMI,height,weight,left and right,multifocal,TG,TPOAb titer and preoperative Hashimoto or not（P>0.05）.The results of univariate analysis showed that the benign and malignant nodules of Bethesda Ⅴ were not related to age,sex,height,weight,left and right,multifocal,Hashimoto and Hashimoto.There were significant differences in boundary,tumor size and echo between the postoperative pathological PTC group and the benign group(P<0.05.There was no significant difference in TIRADS grade and ultrasonic signs（blood flow,shape,relationship with capsule and aspect ratio）before operation.Multivariate analysis showed that boundary,tumor size and echo were risk factors for benign and malignant Bethesda Ⅴ nodules.Among them,the boundary condition is the high risk index,and the tumor size and echo are the low risk index.Prediction formula:P/1-P=e^{2.458+1.468*Boundary-0.810*size-1.135*echo} P represents the probability of Bethesda class V nodules as thyroid cancer.The results of univariate analysis showed that the difference between PTC,Bethesda Ⅴ group and Bethesda Ⅵ group was not related to age,sex,BMI,height,weight,tumor location,left and right,multifocal,TG,tumor diameter,TPOAb titer,preoperative Hashimoto or not（P>0 05）.The results of univariate analysis showed that the difference between Bethesda Ⅴ group and Bethesda Ⅵ group was not related to age,sex,BMI,height,weight,tumor location,left and right,multifocal,tumor diameter,TPOAb titer and preoperative Hashimoto.2There was significant difference in TIRADS grade,aspect ratio and echo between Bethesda Ⅴ group and Bethesda Ⅵ group before operation（P<0.05）.There was no significant difference in ultrasonic signs（blood flow,boundary,shape,calcification and relationship with capsule）.The results of multivariate analysis showed that TIRADS,aspect ratio,relationship with capsule,TPOAb and echo were risk factors for the difference between Bethesda Ⅴ nodules and Bethesda Ⅵ nodules.TIRADS,aspect ratio and relationship with capsule were high risk indexes,while TPOAb and echo were low risk indexes.Prediction formula:P/（1-P）=e^{1.697+0.704*TIRADS+0.569*Aspect ratio+0.496*capsule relation-0.002*tpoab-1.419*echo} P represents the diagnosis rate of Bethesda Ⅵ nodules.Conclusions1.Among the thyroid nodules diagnosed as Bethesda Ⅴ,the larger the maximum diameter of the tumor is,the larger the histopathology may be,and the large,Bethesda Ⅴ nodules may be benign with hypoechoic nodules and unclear boundaries revealed by ultrasound,and the histopathology is more likely to be malignant.2.Bethesda Ⅴ nodules with low TPOAb titer,hypoechoic nodules,aspect ratio>1,unclear relationship with capsule and higher TIRADS grade before operation are more likely to be diagnosed as malignant nodules.