| Part I The Study of Thyroid Nodules with 3-Dimensional Ultrasound and 3-Dimensional Power Doppler UltrasoundPurposeTo observe the sonographic features of thyroid nodules with 3-Dimensional Ultrasound and 3-Dimensional Power Doppler Ultrasound and compare with conventional ultrasound. To assess the value of 3-Dimensional Ultrasound and 3-Dimensional Power Doppler Ultrasound in differentiating benign and malignant thyroid nodules.Material and methodsFrom Mar 2008 to Apr 2009, ninety-four patients scheduled for surgical removal of the nodules were evaluated with 3D ultrasound and 3D-Power Doppler ultrasound. Of the 103 lesions, 50 lesions were benign, 53 were malignant.In 3D ultrasound, with the mltiplanar reformation, the sonographic features of the thyroid nodules were observed for the location with the capsule, shape, margin, halo, internal texture, echogenicity, homogenicity and calcification.In 3D power Doppler ultrasound, with the color mode, the location, quantity, formation, spatial distribution of the thyroid nodules vascular, as well as whether there was the presence of local abundant vascular in the nodules or in the perinodular area of the nodules were observed.To analyse the features of thyroid nodules in the 3D ultrasound and 3D power Doppler ultrasound with respect to the histological results. In additional, the sensitive, specificity, PPV (positive predictive value), NPV(negative predictive value), accuracy of the 3D ultrasound and 3D power Doppler ultrasound were calculated and compared with conventional ultrasound.Results1. Of all the 103 lesions underwent 3D ultrasound examination, 50 (48.5%) were benign and 53 (51.5%) were malignant. The malignant lesions included 48 (90.5%) papillary thyroid carcinoma (PTC), 1 (1.9%) follicular carcinoma, 3 (5.7%) medullary thyroid carcinoma (MTC), 1 (1.9%) lymphoma. The mean size of the malignant lesions was 2.13±1.07cm (0.66cm-5.14cm) , in 73.6% of patients they were stage I. The benign lesions included 40 (80.0%) goiter, 8 (16.0%) adenoma, 1 (2.0%) Hashimoto's disease, 1 (2.0%) fibrous thyroiditis. The mean size of the benign lesions was 2.39±0.96 cm (0.78cm-5.32cm) .2. The sonographic features of 3D ultrasound of benign lesions included regular contours (88.0%), well-defined margin (84.0%), complete and regular halo (54.0%), solid with cystic components (52.0%), iso-echogenicity (66.0%), ununiform echogenicity(72.0%) ,without calcification (64.0%) . The sonographic features of 3D ultrasound of malignant lesions included irregular contours (90.6%), ill-defined margin (47.2%), no halo (62.3%), solid (94.3%), ununiform echogenicity (90.6%), hypo-echogenicity(90.6%), microcalcification (79.2%) .3. The sonographic features of 3D power Doppler ultrasound of benign lesions included regular (96.0%), symmetric (88.0%) vascular, the absence of the local abundant vascular in the nodules (96.0%) and in the perinodular area of the nodules(94.0%) . The sonographic features of 3D power Doppler ultrasound of malignant lesions included irregular (66.2%), asymmetric vascular (56.6%), the presence of the local abundant vascular in the nodules (54.7%) and in the perinodular area of the nodules (60.4%) .4. The sensitivity, specificity, PPV, NPV, ACC of 3D ultrasound were 88.7%, 90.0%, 90.4%, 88.2%, 89.3%, which were superior to 2D ultrasound with the sensitivity/ specificity/PPV/NPV/ACC of 86.8%/86.0%/86.8%/86.0%/86.4%. The sensitivity, specificity, PPV, NPV, ACC of 3D power Doppler ultrasound was 83.0%, 94.0%, 93.6%, 83.9%, 90.3%, which were superior to CDFI with the sensitivity/specificity/ PPV/NPV/ACC of 75.5%/92.0%/90.9%/78.0%/83.5%.ConclusionsThere is significant difference in sonographic features between the benign and malignant thyroid lesions of 3D ultrasound and 3D power Doppler ultrasound. The sensitivity and specificity of 3D is superior to 2D ultrasound. The sensitivity and specificity of 3D power Doppler ultrasound is superior to CDFI. 3D ultrasound and 3D power Doppler ultrasound provide more information of the thyroid nodules and are of great value in diagnosing and differentiating thyroid nodules. Part II Ultrasound-guided fine-needle aspiration and core-needle biopsy in the diagnosis of thyroidObjective1. Evaluate the efficacy of ultrasound-guided fine-needle aspiration (US-FNA) and core needle biopsy (US-CNB) of thyroid nodules.2. To assess the value of Thin-Layer preparation (TP) in diagnosing thyroid disease and compared with conventional preparation (CP) .Material and methods175 thyroid FNA were prospectively performed on 168 patients ranging from 4 to 75 years of age.53 thyroid CB were prospectively performed on 53 patients ranging from 13 to 74 years of age.57 thyroid FNA were performed with TP preparation simultaneously.The cytology and histological diagnoses were categorized into four groups: benign, malignant, suspicious, and unsatisfactory. Analysis the character of cytology of TP.Results1. There were 39 malignant nodules and 136 benign nodules proved by histological diagnoses and clinical follow-up. One hundred and twenty four (71%) of the aspirates were diagnosed as "benign", twenty four (14%) were diagnosed as "malignant", fourteen (8%) were diagnosed as "suspicious for malignant", thirteen (7%) were read as unsatisfactory for interpretation. Sensitivity of thyroid FNA in diagnosing thyroid malignancy relative to final histological diagnoses and clinical follow-up was 81.1%, specificity was 93.6%, accuracy was 90.7%, PPV was 78.9%, NPV was 94.4%. 7 cases was false negative. 8 cases was false positive. Bleeding was observed in 3 nodules(1.7%).2. Sensitivity/specificity/accuracy/PPV/NPV of US-FNA in diagnosing solid thyroid nodule was 82.9%, 91.7%, 88.8%, 82.9%, 91.7%. Sensitivity/ specificity/ accuracy/PPV/NPV of US-FNA in diagnosing cyst-solid thyroid nodule was 50.0%, 96.3%, 94.6%, 33.3%, 98.1%.3. Sensitivity/specificity/accuracy/PPV/NPV of US-FNA in diagnosing solid thyroid nodule with a diameter of 1cm or smaller was 75.0%, 96.7%, 94.1%, 75.0%, 96.7%. Sensitivity/specificity/accuracy/PPV/NPV of US-FNA in diagnosing solid thyroid nodule with a diameter larger than 1cm was 83.9%, 88.1%, 86.3%, 83.9%, 88.1%.4. There were 22 malignant nodules and 31 benign nodules proved by histological diagnoses and clinical follow-up. Thirty five (66%) of the biopsies aspirates were diagnosed as "benign", fifteen (28%) were diagnosed as "malignant", two (4%) were diagnosed as "suspicious for malignant", one (2%) was read as unsatisfactory for interpretation. Sensitivity of thyroid FNA in diagnosing thyroid malignancy relative to final histological diagnoses and clinical follow-up was 81.0%, specificity was 100%, accuracy was 92.5%, PPV was 100%, NPV was 88.6%. Bleeding was observed in 2 nodules (3.8%).5. The inadequate rate of TP is 8.8%, compared with conventional smears, the cytology character of TP included markedly decreased background blood cells, decreased or dense colloid, more cell shrinkage, densely stained nuclear, disruption of the cytoplasm and numerous naked nuclei.Conclusions1. US-FNA and US-CNB were accurate and reliable methods to diagnose thyroid nodules.2. The specificity and PPV of CNB is a little higher than FNA. The sensitivity of FNA is a little higher than CNB. FNA is more convenient and safe, with satisfactory efficacy.3. The sensitivity of FNA is high in diagnosing solid thyroid nodules but relatively low in diagnosing cyst-solid thyroid nodules. We should interpret the results in consideration with different clinical conditions.4. The combination of cytological smears and histological cell block helps to detect malignant thyroid nodules.5. Thin-layer preparation is of great value in diagnosing thyroid disease, the character of the cytology is different from conventional preparation. |
