Research On The Prediction Of Mixed Benign Thyroid Nodules With Spontaneous Intracystic Hemorrhage And Main Technology Of Microwave Ablation

PurposeTo explore the ultrasonographic characteristics and predictive value of spontaneous intracystic hemorrhage in mixed benign thyroid nodules,and the early intervention of such nodule was performed by microwave ablation with priority to ablation aspiration needle tract,so as to optimize the management of patients with mixed benign thyroid nodules.Materials and MethodsThe research was divided into two stages.The first stage: We retrospectively analyzed 101 mixed benign thyroid nodules from September 2015 to December 2017.Grouping according to the presence of spontaneous intracystic hemorrhage(group A: 59 nodules with spontaneous intracystic hemorrhage,group B: 42 nodules without spontaneous intracystic hemorrhage).The age,gender,follow-up time,and the initial maximum diameter,blood supply,composition,and solid part characteristics of the nodules were compared between the two groups at the first ultrasound examination.Univariate and multivariate analysis were used to evaluate the relationship between spontaneous intracystic hemorrhage and ultrasound characteristics.ROC analysis was used to evaluate the application value of each factor in predicting hemorrhaging.The second stage: We retrospective evaluated 87 mixed benign thyroid nodules that underwent microwave ablation from June 2017 to August 2019.Grouping according to whether priority ablating the aspiration needle tract(group A: 52 nodules with priority ablating the aspiration needle tract,group B: 35 nodules without priority ablating the aspiration needle tract).Baseline characteristics,intervention time,hospital stays,nodules with intraoperative intracystic hemorrhage,and postoperative complications were compared between the two groups.Volume,volume reduction rate(VRR),compressive score(CS),and aesthetic score(AS)were evaluated during follow-up time.The Mann-Whitney-U test was used to compare the volume and VRR between the two groups after microwave ablation.Results1.The results of the first stage of the study showed,there was no significant difference in age and gender follow-up time between the two groups(P>0.05),there was no significant difference in the maximum initial nodule diameter,intranodular components,echoes and calcifications of the nodular solid part between the two groups(P>0.05).Spontaneous intracystic hemorrhage of nodules was associated with rough edges of solid parts,abundant blood supply and spongy content(P< 0.05).After multielement logistic regression analysis,abundant blood supply and spongy content were independent predictors of spontaneous intracystic hemorrhage of nodules.ROC analysis of these predictors showed a sensitivity of 62.7%,specificity of 95.2%,and AUC of 0.881.2.The results of the second stage of the study showed,both groups achieved decreases in volume,CS,and AS,as well as an increase in VRR.At 1,3,6 and 12 months,the volume of group A was significantly smaller than that of group B,and VRR was larger than that of group B(P < 0.05).The incidence of intraoperative intracystic hemorrhage in group A was significantly lower than that in group B(P < 0.05).There were no significant differences in intervention time,hospital stays,cystic fluid volume or postoperative complications(P>0.05).ConclusionUltrasonographic findings showed mixed benign thyroid nodules with abundant blood supply,rough solid edges and spongy internal contents,which were prone to spontaneous intracystic hemorrhage.Aspiration needle tract ablation dramatically reduces the incidence of intraoperative intracystic hemorrhage and markedly improves the efficacy and safety of microwave ablation for mixed benign thyroid nodules.