| Background and Objective:Epidemiological statistics, random selection in the crowd, ultrasound found at arate of19%-19%of thyroid nodules, thyroid cancer found at a rate of5%-5%, anda marked increase in the incidence of thyroid cancer in recent years, with the mostcommon thyroid papillary carcinoma. Ultrasound has become the routine inspectionmethod of identification of benign and malignant thyroid nodules, but in differenthospitals, different ultrasound doctors knowledge of nodules and description is notconsistent, affect the thyroid physician for diagnosis and treatment of thyroid nodule.In order to unify and standardize the thyroid nodule ultrasound report described, toprovide more accurate information for clinicians, further guide clinical treatment. AsHorvath and draw lessons from the United States in2009of radiology Breast imagingreporting and data system (Breast imaging reporting anddata system, BI-RADS)ultrasonic diagnostic criteria, classification for the first time put forward the thyroidimaging reporting and data system (TI-RADS) hierarchical diagnostic criteria.Thyroid nodule ultrasound image characteristics of changeable and cross, betweenbenign and malignant lesions two-dimensional ultrasonographic features of similarand different ultrasound doctors diagnose experience is different, the same lesions may give different classification. Shear wave ultrasonic elastography (SWE) is a kindof can direct quantitative measurement organization hardness values of the newultrasonic diagnosis technology. This study intended to explore TI-RADS grading,shear wave elastography in differentiating benign and malignant thyroid nodulerespective diagnostic value, and further improved by combining new technology ofshear wave elastography TI-RADS grading, look to whether can help improve the TI-RADS classification in the diagnosis of benign and malignant thyroid nodulediagnosis, in order to better guide the clinical diagnosis and treatment of thyroidnodule.Materials and Methods:1. The first part collected from June,2013to December,2013of ultrasonicexamination revealed thyroid nodule surgical treatment of128cases. All nodulepreoperative adopt Horvath TI—RADS diagnostic criteria of evaluation, confirmedby pathology after surgery. In order to contrast with the pathological results better,this study only included in the thyroid nodule TI—RADS category for3to5,gray-scale sonography with a solid performance for single.With pathologic results asthe gold standard, TI-RADS classification and pathological result comparison, drawthe ROC curve, area under the ROC curve evaluation TI-RADS classification valueto the diagnosis of benign and malignant thyroid nodule.2. The second part of the128nidus and35normal cases were examined by shearwave imaging, measured thyroid nodule and normal thyroid young’s modulus value,and with the pathological results as the "gold standard", ROC curve was drawn,through the area under the ROC curve evaluate the value of young’s modulus in thediagnosis of thyroid nodules, reference boundary value analysis and identification ofbenign and malignant lesions.3. The reference in the second part of this research results for the identificationof benign and malignant lesions of the reference value. When the young’s modulusaverage> reference boundary，TI-RADS category for3nodules rose to4a，TI-RADS category for4a nodules rose to4b；When the young’s modulus average≤reference boundary， TI-RADS category for4b fell to4a. TI-RADS category for5unchanged by SWE. Drawn in pathologic results as the gold standard, the area underthe ROC curve (AUC), Compared the improved TI–RADS is combined with SWEto the original TI-RADS diagnostic criteria area under the ROC curve and the valueof the diagnosis of thyroid nodules. Results:1.128thyroid nodules, included73malignant nodules and55Benignnodules.Accorded to contrast TI-RADS and pathological results,drew ROC curve,the area under the curve (AUC) was0.866，the sensitivity was83.6%，the specificitywas82%.2. The average Young’s modulus of Benign lesion group, malignant lesion groupand normal control group respectively were (23.92±15.5) Kpa，(80.47±29.39) Kpaand (16.34±4.77) Kpa，between different groups was statistically significant，P <0.05；The average Young’s modulus in the diagnosis of malignant lesions of thyroidnodule AUC was0.89，with nodules average Young’s modulus of52.85kPa as adiagnostic value，the diagnostic sensitivity was95.9%，the specificity was71.7%.3. Accorded to contrast the modified TI-RADS and pathological results,drewROC curve，the AUC was0.931，the sensitivity was90.4%，the specificity was92.7%.The AUC of modified TI-RADS and the original TI-RADS were0.866,0.931，andcomparison was statistically significant (P <0.05).Conclusion:1. TI—RADS in ultrasonic examination had important diagnostic value inthyroid nodules，further treatment had good guidance for clinical value.2. Shear wave elastography could quantitatively evaluate thyroid tissue hardness,measured the average Young’s modulus could help the differential diagnosis ofbenign and malignant thyroid nodule nodules.3. The combination of shear wave elastography improved TI—RADShierarchical diagnostic criteria for identification of benign and malignant thyroidnodules had high diagnostic value. |
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