Exploration Of The Preoperative Differential Diagnosis Of Follicular Thyroid Neoplasms Based On Ultrasonography And Serum Markers

ObjectiveThis study attempted to investigate the model of preoperative differential diagnosis of follicular thyroid neoplasms,based on the differences between sonographic features of follicular thyroid neoplasms,ultrasound risk stratification systems for thyroid nodules,and conventional and straightforward serum markers related to thyroid,including thyroglobulin(Tg),antithyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb),thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4).Subjects and MethodsConsecutive patients diagnosed with follicular thyroid carcinoma(FTC)and follicular thyroid adenomas(FTA)between January 2014 and April 2021 at Guangdong Provincial People’s Hospital based on surgical pathology following thyroidectomy were included in this study.Clinical data were analyzed between FTC and FTA,including pathology,demography,Ultrasonography,and serum markers.The diagnostic models were built by univariate and multivariate logistic regression and visualized by Nomogram.The calibration degree and validity of the diagnostic models were evaluated.All statistical analyses were performed using SPSS Statistics,MedCalc Statistical Software,and R Software.ResultsIn this study,303 patients with follicular thyroid neoplasms were included,including 62(20.5%)FTC and 241(79.5%)FTA.Among them,there were 255 patients who were negative for TgAb(<115.00 IU/mL),including 48(18.8%)FTC and 207(81.2%)FTA.In the whole cohort,AUC of the superior model was 0.732(95%CI:0.658-0.806,P<0.001);the independent risk factors of FTC included class 4B,4C or 5 nodules in C-TIRADS(OR=4.759,95%CI:1.600-13.974,P=0.005),irregular shape(OR=5.658,95%CI:1.217-26.317,P=0.027)and higher group of TgAb levels(<11.68 IU/mL;11.68-29.49 IU/mL;≥29.50 IU/mL)(OR=2.019,95%CI:1.402-2.907,P=0.001),while higher levels of FT3(pmol/L)was an independent protective factor(OR=0.695,95%CI:0.492-0.983,P=0.040).In TgAb(-)cohort,AUC of the superior model was 0.778(95%CI:0.698-0.858,P<0.001);independent risk factors of FTC included class 4B,4C or 5 nodules in C-TIRADS(OR=4.985,95%CI:1.421-17.493,P=0.012),irregular shape(OR=5.658,95%CI:1.217-26.317,P=0.027),higher group of Tg levels(<42.35 ng/mL;42.35-109.79 ng/mL;109.80-437.59 ng/mL;≥437.60 ng/mL)(OR=1.632,95%CI:1.173-2.270,P=0.004)and group of TgAb levels(<10.13 IU/mL;10.13-14.57 IU/mL;≥14.58 IU/mL)(OR=1.842,95%CI:1.219-2.784,P=0.004).ConclusionsFirstly,irregular shape,class 4B/4C/5 nodules of C-TIRADS,higher group of Tg(ng/mL)and TgAb(IU/mL)levels were the independent risk factors of FTC,while higher titers of FT3(pmol/L)was an independent protective factor of FTC.Secondly,combined ultrasonography with serum markers may be helpful for preoperative differential diagnosis of thyroid follicular tumor.Still,more effective diagnostic models should be explored for the preoperative differential diagnosis of follicular thyroid neoplasms to improve their management.