The Value Of Shear Wave Elastography And ACR TI-RADS Stratification In Differential Diagnosis Of Benign And Malignant Thyroid

Objective To assess the application value of shear wave elastography(SWE)in combination with Thyroid Imaging Reporting and Data System(TI-RADS)set by the American College of Radiology(ACR)in differential diagnosis of malignant and benign thyroid nodules.Methods 102 patients who underwent thyroid ultrasound examination in the First Affiliated Hospital of Jinzhou Medical University from July 2017 to December 2018 were collected,with a total of 113 nodules,including 51 benign nodules and 62 malignant nodules.A retrospective analysis of 113 thyroid nodules with ultrasonographic imaging data was carried out.All the nodules underwent SWE and conventional ultrasonic examinations.With pathology as the gold standard,the receiver operating characteristic(ROC)curve was drawn and the best diagnostic cut-off of SWE and ACR TI-RADS was selected for comparing their diagnostic performance.To compare the value of single application of SWE,ACR TI-RADS and the combined application of the two diagnostic methods in the diagnosis of benign and malignant thyroid nodules.Results 1.The maximum and average Young’s modulus of benign nodules were(34.2±11.9)kPa and(22.9±8.4)kPa.The maximum and average Young’s modulus of malignant nodules were(54.7±17.4)kPa and(29.2±9.1)kPa.The difference between the maximum and average values of Young’s modulus of benign and malignant nodules was statistically significant(P<0.05).The area under the ROC curve of the maximum and average values of Young’s modulus in thyroid nodules for the diagnosis of malignant lesions were 0.827 and 0.687(P< 0.05).The best cut-off point for diagnosing malignant by the maximum Young’s modulus was 40 kPa.And at that point,the sensitivity,specificity and accuracy of the average value of it were 74.2%,76.5% and 75.2 %.2.Best cut-off point for diagnosing malignant by ACR TI-RADS was TR4.The sensitivity,specificity and accuracy of thyroid nodule malignancy diagnosed with grade greater than 4 were 80.6%,78.4% and 79.6%.3.The sensitivity,specificity and accuracy of the combination of SWE and ACR TI-RADS in diagnosis of benign and malignant thyroid nodules were 93.5%,68.6% and 82.3%.The sensitivity of the combination of the two examinations was significantly higher than that of simple application of each of them(P<0.05),there was no significant difference in the specificity and accuracy between them(P>0.05).Conclusions 1.The hardness of thyroid nodules can be quantitatively evaluated by SWE.The maximum value of Young’s modulus is better than the average value and the minimum value of Young’s modulus,and the best cut-off point of the maximum value of Young’s modulus in the diagnosis of benign and malignant thyroid nodules is 40 kPa.2.ACR TI-RADS had a clinical value in the qualitative diagnosis of thyroid nodules.Best cut-off point for diagnosing malignant by ACR TI-RADS was TR4.3.Compared with simple application of each of them,application of SWE in combination with ACR TI-RADS can improve the sensitivity of thyroid nodules diagnosis without loss of specificity and accuracy.