The Value Of Fine-Needle Aspiration Biopsy And Elastography In The Diagnosis Of Thyroid Nodules And The Analysis Of Related Influencing Factors

Section I The value of fine-needle aspiration biopsy combined with elastography in the diagnosis of thyroid nodulesObjective To evaluate the diagnostic value of ultrasound-guided fine-needle aspiration(US-FNAB)combined with real-time ultrasound elastography(RTE) in the diagnosis of suspicious thyroid nodules.Methods A retrospective analysis of 84 patients with 105 suspicious thyroid nodules in our hospital was undertaken, including corresponding examination of conventional ultrasound, RTE and US-FNAB. RTE scores and FNA cytopathology results were evaluated respectively, and then were compared with surgical biopsy and clinical follow-up for analysis.Results In the 105 included thyroid nodules, 68 were benign(68/105, 64.76%) and 37 were malignant(37/105,35.24%) confirmed by surgical biopsy and clinical follow-up. The combined diagnosis of conventional US and RTE had a sensitivity of 72.97%(27/37), a specificity of 30.88%(21/68)and an accuracy of 45.71%(48/105) in the diagnosis of thyroid nodules. While the corresponding sensitivity, specificity and accuracy of further FNA cytopathology were 75.68%(28/37), 88.24%(60/68) and 83.81%(88/105), respectively. Though there was no statistically significant difference in the diagnostic sensitivity(P>0.05), the difference of specificity and accuracy between further US-FNAB and the combined diagnosis of conventional US and RTE was found significant( P<0.05).Conclusion For all the diagnoses of thyroid nodules, there is certain limitation in both the combined application of conventional US with RTE and further US-FNAB. However, as to some suspicious thyroid noudules which is difficult to diagnose with the combined application of conventional US with RTE, fine needle aspiration cytopathology could help provide higher specificity and accuracy for predicting thyroid malignancy.SectionⅡThe analysis of influencing factors in the diagnosis of thyroid nodules with fine-needle aspiration and elastographyObjective To analyze the influencing factors of ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and real-time ultrasound elastography(RTE)in diagnosis of thyroid nodules.Methods A retrospective analysis of 116 patients with 142 thyroid nodules was undertaken, including corresponding examination of conventional ultrasound,RTE and US-FNAB. Comparison of the two methods in the accuracy rate of diagnosis was made in thyroid nodules of different size, with or without the coexistence of Hashimoto’s thyroiditis(HT).Results In 142 included thyroid nodules, 81 were benign and 61 were malignant confirmed by surgical biopsy and clinical follow-up. The diagnosis of conventional ultrasound and RTE had a sensitivity of 83.61%(51/61), a specificity of 30.88%(21/68) and an accuracy of 55.63%(79/142). While the corresponding sensitivity, specificity and accuracy of US-FNAB were86.89%(53/61), 97.53%(79/81), 92.96%(132/142), respectively. Among different size groups(≤5mm, 5 ~ 10 mm, 10 ~ 20 mm, >20mm), diagnostic accuracy of RTE was 56.25%,48.05%, 65.79%, 72.73%, while diagnostic accuracy of US-FNAB was 93.75%, 94.81%,89.47%, 90.91%, respectively. There was no statistically significant difference in the diagnostic accuracy of both RTE and US-FNAB between different size(P > 0.05). Among groups with or without the coexistence of Hashimoto’s thyroiditis, diagnostic accuracy of RTE was 43.14%, 53.85%. While diagnostic accuracy of US-FNAB was 88.24%, 94.51%,respectively. There was also no statistically significant difference in the diagnostic accuracy of both RTE and US-FNAB between HT and non-HT group(P>0.05).Conclusion In the diagnosis of thyroid nodules, size and coexistence of Hashimoto’s thyroiditis seemed not to be the the influencing factors of US-FNAB and RTE. However, both of the two new techniques could provide more valuable information in addition to conventional sonographic features for the diagnosis of suspicious thyroid nodules.