The Differential Diagnostic Value Of ⁹⁹Tc^mO₄^- Thyroid Scintigraphy Plus Serum Tsh In High-risk Thyroid Nodules By Ultrasound

Objective:To evaluate the diagnostic value of ⁹⁹Tc^mO₄^-thyroid imaging、ultrasound and serum TSH for differentiating benign and malignant TI-RADS category 3and 4 thyroid nodules（thyroid imaging reporting and data system）.Methods:Retrospective analysis of the clinical data including preoperative serum TSH level,thyroid ultrasound and thyroid static imaging of 220 patients with TI-RADS3 and 4 type thyroid nodules.To evaluate the diagnostic value of color Doppler ultrasonography、⁹⁹Tc^mO ₄^-radionuclide imaging,and their combination in thyroid nodules.And evaluate the diagnostic value preoperative serum TSH in thyroid nodules.The receiver operating charecteristic curve analysis and trend chi-square test were conducted to assess the relationship between TSH and thyroid carcinoma.Results:（1）There were 46 nodules were confirmed as thyroid cancer and 174 were confirmed as benign thyroid disease among 220 nodules.（2）When a cut-off value of 0.637μIU/m L was used,the sensitivity、specificity and AUC of using the serum TSH level as a diagnostic biomarker in patient with all thyroid nodule were 85.8%、42.7%and0.641,respectively.When a cut-off value of 0.670μIU/m L was used,the sensitivity、specificity and AUC of using the serum TSH level as a diagnostic biomarker in patient with TI-RADS category 4 thyroid nodules were86.4%、40.3%and 0.627,respectively.When a cut-off value of 1.683μIU/m L was used,the sensitivity、specificity and AUC of using the serum TSH level as a diagnostic biomarker in patient with thyroid cold nodules were 79.8%、82.5%and 0.79,respectively.When a cut-off value of 1.625μIU/m L was used,the sensitivity、specificity and AUC of using the serum TSH level as a diagnostic biomarker in patient with TI-RADS grade 4 thyroid cold nodules were 81.8%、83.3%and 0.83,respectively.Conclusions:（1）Thyroid ⁹⁹Tc^mO₄^-radionuclide imaging had certain application value in differential diagnosis of malignant thyroid nodules,and could provide functional information for thyroid.Ultrasound combined with radionuclide imaging could reduce the needless nodular puncture or surgery.（2）Preoperative serum TSH can be used as a supplementary predictor of TI-RADS grade 4 cold nodules.