| Part one:A comparative study of three ultrasound classification systems in evaluating the value of benign and malignant thyroid nodules Objective:To compare the diagnostic performance and the unnecessary biopsy rates for recommending fine needle aspiration of Thyroid Imaging Reporting and Data Systems proposed by American College of Radiology(ACR TI-RADS)in 2017,《Clinical practice guidelines for the diagnosis and management of thyroid nodules》(AACE/ACE/AME)jointly proposed by the American Association of Clinical Endocrinologists(AACE),the American College of Endocrinology(ACE)and the Association Medici Endocrinologi(AME)in 2016,American Thyroid Association(ATA)guidelines in 2015 for malignancy risk stratification of thyroid nodules.Research data and methods:Data of 1254 nodules in 1254 patients who underwent thyroid ultrasound and thyroidectomy or ultrasound-guided fine needle biopsy in the Department of Ultrasound of the First Affiliated Hospital of Gannan Medical College from June2018 to December 2019 were retrospectively collected,And nodules were classified according to three methods of ultrasonic classification,histopathologic results and fine needle biopsy pathology as the "gold standard",build the receiver-operating characteristic curve,according to an index about selecting optimal diagnostic critical value and compare three methods of ultrasonic classification identification of benign and malignant thyroid nodule diagnosis efficiency and recommend fine needle biopsy rate of unnecessary biopsies.Result:1.A total of 1254 nodes into research,669(53.35%)nodules are benign,585(46.65%)nodules were malignant,solid nodules of the malignant rate(64.4%)significantly greater than mainly solid and mainly cystic mixed nodules(7.6%,8.4%),malignant in Marked hypoechogenicity,hypoechogenicity nodules(91.3%,72.3%)significantly greater than Iso-Hyperechogenicity /high echo(10.6%),edge malignant in irregular nodules(85.3%)were significantly higher than that of edge rules nodules(17.5%),The malignancy rate of microcalcified nodules(87.4%)was higher than that of coarse calcified nodules(39.4%)and non-calcified nodules(28.4%).The malignancy rate of nodules with Taller than wide(83.8%)was higher than that of nodules with Wider than tall(29.6%),and the differences were statistically significant(P < 0.001).2.The malignant rates of TR1,TR2,TR3,TR4 and TR5 were 0%(0/34),2.23%(3/134),4.09%(15/366),49.10%(55/112)and 84.21%(512/608)in ACR TI-RADS ultrasonic classification evaluation,and there was statistical significance among different categories(P<0.001).In the classification assessment of AACE/ACE/AME guidelines,the malignancy rates of low risk,medium risk and high risk were 0.59%(31/522),34.82%(39/112)and 82.93%(515/621),respectively,and there was statistically significant difference among different categories(P<0.001).In the classification assessment of ATA guidelines,the malignant rates of benign,very low suspicion,low suspicion,moderate suspicion and high suspicion were 0%(0/22),1.85%(3/159),10.65%(36/338),27.35%(32/117)and 83.58%(514/615),respectively,and there was statistical significance among different categories(P<0.001).3.ACR TI-RADS ultrasonic classification of the best cut-off point for diagnosis of benign and malignant classification is TR4,AACE/ACE/AME guidelines of the best cut-off point for diagnosis of benign and malignant classification is the higher risk lesions,ATA guidelines of the best cut-off point for diagnosis of benign and malignant classification is the highly suspected malignant,respectively to calculate the three kinds of classification of the sensitivity,specificity,positive predictive value,negative predictive value and accuracy,Youden index and area under curve(AUC),ACR TI-RADS classification was 96.92%,77.13%,51.4%,99.0%,86.52%,0.740,0.905;AACE/ACE/AME guideline was 88.03%,84.16%,58.1%,96.6%,85.96%,0.721,0.883;ATA guideline was 87.86%,85.05%,59.5%,96.6%,86.28%,0.729,0.886;ACR TI-RADS classification had the highest sensitivity,negative predictive value and accuracy,ATA guide had the highest specificity and positive predictive value,There was statistically significant difference between ACR TI-RADS classification and ATA and AACE/ACE/AME guidelines(P < 0.05).4.Classification of ACR TI-RADS recommend to FNA nodule number was 600,number of benign nodules was 263,unnecessary biopsy rate was 43.83%,AACE/ACE/AME guidelines recommend to FNA nodule number was 642,number of benign nodules was 317,unnecessary biopsy rate was 49.37%,the ATA guidelines recommend to FNA nodule number was 649,number of benign nodules was 331,unnecessary biopsy rate was 51.00%.There was a statistically significant difference between the ACR TI-RADS classification and the ATA guidelines and AACE/ACE/AME guidelines in the rate of unnecessary biopsy recommended by the three guidelines(P< 0.05).Conclusion: The three ultrasonic classification systems have good diagnostic efficacy in differentiating benign and malignant thyroid nodules.The overall diagnostic efficacy of ACR TI-RADS classification is better than ATA and AACE/ACE/AME guidelines.The ACR TI-RADS classification had a lower rate of unnecessary biopsies than the ATA and AACE/ACE/AME guidelines,and the ACR TI-RADS classification was more accurate in the identification of suspicious nodules recommended for fine needle aspiration than the ATA and AACE/ACE/AME guidelines.Part two:The benign and malignant value of ACR TI-RADS classification in diagnosing nodules with Hashimoto’s thyroiditis Objective:To explore the application value of the thyroid imaging report and data system(TI-RADS)recommended by the American College of Radiology(ACR)in 2017 for the differentiation of benign and malignant thyroid nodular lesions with Hashimoto’s thyroiditis(HT)based on two-dimensional ultrasound signs.Research data and methods:The ultrasonic data of 105 patients with HT thyroid nodules(146 cases in total)who who underwent thyroid ultrasound and thyroidectomy in the Department of Ultrasound of the First Affiliated Hospital of Gannan Medical College from September 2019 to September 2020 were retrospectively analyzed,Using ACR TI-RADS classification in 2017 to evaluate nodules ultrasonographic features,including the composition of nodules,echo,shape,edge and focal strong echo with grading and classification,The lesions were divided into malignant group and benign group,and the ultrasonographic signs of the two groups were statistically analyzed,histopathologic results as the "gold standard",build the receiver-operating characteristic curve,The sensitivity,specificity,accuracy and AUC of ACR TI-RADS classification score in the diagnosis of thyroid malignant nodules with HT were obtained.Result:1.A total of 146 nodules into research,68 nodules are malignant,78 nodules are benign;There were statistically significant differences in composition,echo,morphology,margin and focal strong echo between the benign group and the malignant group(all P<0.05).Among the features of focal strong echo,there was no strong echo or large comet tail and spotty strong echo calcification with statistical significance(all P <0.001),while there was no statistical significance in coarse calcification,peripheral calcification or ring calcification with statistical significance(all P < 0.05).2.The area under the ROC curve for the 2017 ACR TI-RADS classification diagnosis with HT thyroid malignant nodules was 0.945(P<0.001),the best critical score was 4.5,the sensitivity was 92.6%,the specificity was 84.6%,and the accuracy was 88.36%.Conclusion:ACR TI-RADS classification based on two-dimensional ultrasound signs to distinguish benign and malignant thyroid nodules with HT has a high accuracy,simple and easy to perform,and is convenient for clinical application. |
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