Study On The Value Of C-TIRADS Combined With SWE For The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective To investigate the diagnostic efficacy of SWE technique elastic modulus quantification parameters on benign and malignant thyroid nodules;to explore the diagnostic value of C-TIRADS combined with SWE in the differential diagnosis of thyroid nodules.Methods 1.During the period 2021.9-2022.8.17,62 patients with thyroid nodules(73nodules)underwent ultrasound and SWE in our department and pathological results were obtained.The quantitative parameters of the elastic modulus of the SWE technique were selected to analyze the diagnostic value of benign and malignant thyroid nodules,and to compare the diagnostic efficacy of each parameter for the nodules,while using the pathological results as the gold standard.2.According to the C-TIRADS guideline criteria,C-TIRADS 4A and below were diagnosed as benign,and C-TIRADS 4B and above were diagnosed as malignant,and the benign and malignant nodules were classified and diagnosed.3.Using the SWE technique,the Emax value was taken as a quantitative parameter to assist in C-TIRADS classification according to the results of the study obtained above,and Emax ≥ 46.1 kpa was used as the diagnostic criterion for benign-malignant differentiation according to the reference value shown in the Clinical Application Guidelines for Ultrasound E Imaging.If the SWE diagnosis was Emax < 46.1 kpa,the classification was adjusted downward by one level,and if the SWE diagnosis was Emax < 46.1kpa,the classification was adjusted upward by one level.It was no longer adjusted downward for category 2 nodules and no longer adjusted upward for category 5 nodules.The differential diagnostic performance of these two methods for benign and malignant thyroid nodules was compared and analyzed using C-TIRADS alone and in combination with the SWE technique for reclassification of thyroid nodules,using pathological findings as the gold standard.Results 1.Of the 73 thyroid nodules,31 were benign and 42 were malignant.The elastic modulus’ mean Emean,maximum Emax,standard deviation Esd and minimum Emin of malignant nodules were significantly higher than those of benign nodules,and the difference was significant(P < 0.05),statistically.The ROC curve was used to analyze the discriminative efficacy of the SWE technique elastic modulus quantification parameters Emean,Emax,Esd,and Emin,and the results showed that the AUC was the largest for Emax values.2.Using the C-TIRADS guideline classification alone,the sensitivity and specificity of the C-TIRADS classification for the diagnosis of malignant thyroid nodules in this study were 88.1%,41.94%,respectively.3.The total number of thyroid nodules diagnosed as C-TIRADS4B/4C/5(suspicious of malignancy)was significantly reduced(44/73,60.27%)after combined SWE-assisted diagnosis.The sensitivity and specificity of C-TIRADS classification with SWE-assisted diagnosis were 85.71% and 74.19%,respectively,and its specificity was significantly higher than using the C-TIRADS alone(74.19% versus41.94%,P < 0.05),while the sensitivity was 85.71% versus 88.1%,P > 0.05,respectively,which was not statistically significant.The AUC for diagnosis using the C-TIRADS classification alone was 0.728,whereas the AUC after its reclassification by the combined SWE technique was 0.844,for which the difference was statistically significant using the Z test,P < 0.05.Conclusions 1.The quantitative indices of elastic modulus Emean,Emax,Esd,and Emin of benign and malignant thyroid nodules measured by shear wave elastography are statistically different and have some diagnostic value in identifying both benign and malignant thyroid nodules.Among the elastic modulus quantifiers Emean,Emax,Esd,and Emin of shear wave elastography,Emax has the best diagnostic efficacy.2.C-TIRADS guidelines have a high sensitivity but low specificity in diagnosing benign and malignant thyroid tumors.The combination of real-time shear wave elastography,or SWE technology,can further improve the diagnostic efficacy of C-TIRADS,and has some clinical application value in reducing unnecessary surgical treatment and reducing the physiological and psychological burden of patients under the possibility of overdiagnosis of thyroid nodules today or in existence.