| Objective:Give a value assignment to the most significant factors which we have filtered out from medical records and then select the assignment that both sensibility and specificity are both at high levels as a new new standard of diagnosis for benign and malignant thyroid nodules.Methods:To make a study on the influencing factors about the diagnosis of thyroid nodules of5181patients, including age, sexuality, occupation, regional distribution, course of disease, anamnesis and ultrasound features. The relationships were analyzed between the factors above and benign or malignant nodules. Screen out the most significant factors by Logistic regression analysis and find out an assignment that both sensibility and specificity are both at high levels by assign different values to the factors we have filtered out and sum the values. Applied Logistic Regression Model, drawing ROC curves and calculate the area under the curve (AUC) to evaluate the diagnostic value of each index and select the assignment that both sensibility and specificity are both at high levels as a new new standard of diagnosis for benign and malignant thyroid nodules.Results:Of all the factors above, age, anamnesis, course of disease, occupation and ultrasound features are proved statistically significant for the diagnosis of thyroid nodules through the statistics software of SPSS19.0. With stepwise non-conditional Logistic regression analysis to these factors by giving them values with no difference, echo intensity (X1), shape (X2), age (X3), echo structure (X4), calcification type (X5), margins (X6), blood (X7), anamnesis (X8), course of disease (X9),number (X10),size (X11) occupation (X12) and lymph gland (X13) enter the equation as independent risk factors. The regression equation is P=1/[1+e∧(-3.012+0.663*X3+0.259*X8+0.246*X9+0.224*X12+1.165*X1+1.185*X2+0.598*X5+0.697*X4+0.485*X6+0.524*X7+0.207*X13+0.478*X11-0.452*X10)], Hosmer and Lemeshow test, x2=14.844, P=0.062>0.1, AUC=0.814, the diagnostic cut-off point is P=0.341, the diagnostic sensitivity and specificity were75%and75.1%. Sum the values and draw ROC curve, AUC=0.793, the diagnostic cut-off point is P=4.5, the diagnostic sensitivity and specificity were75.7%and71.5%. Give different values to the factors which enter the equation and repeat the above steps. At last we can obtain the best assignment: age (≥40years、<40years:0、1), course of disease(≥1year,6months-lyear,≤6months:0、1、2), anamnesis (no anamnesis、have the history of hypertension or thyroid diseases or mammary gland:0、1), echo structure (Cystic or Cystic and solid、solid:0、3), margins (defined、ill-defined:0、3), shape (regular、irregular:0、4), calcification type (no calcification、macro-calcification、micro-calcification:0、2、4), echo intensity (equal or high level、low level:0、4), blood (not rich、rich:0、3), size (≥1cm、1cm:0、1),family history (have family history、have no family history:0、1) and occupation(have nojob、have a job:0、1), lymph gland (normal、abnormal:0、1),, the diagnostic cut-off point is9.5, the diagnostic sensitivity and specificity were75%and76%。Conclusions:1. This study is the first time which give a value assignment to color Doppler ultrasound characters and other general condition for patients of thyroid nodules, and obtain a new standard of diagnosis for benign and malignant thyroid nodules both at home and abroad. 2.From the single-factor analysis, factors related to the benign/malignant thyroid nodules are age, course of disease, occupation, anamnesis, size, number, echo intensity, echo structure,shape, calcification type, blood, margins.3. From the multi-factor analysis, age, course of disease, occupation, anamnesis, echo structure, echo intensity, shape, calcification type, blood, margins are independent influencing factors.4. Of the general information factors, age, course of disease, occupation, anamnesis have some value for the diagnosis of thyroid nodules, but the sensitivity and specificity is not satisfactory.5. Ultrasound features have certain valuable for the diagnosis of thyroid nodules.6. Analyze factors of both general information and ultrasound features could raise the diagnosis rate and obtain a better prognosis than analyze single ultrasound features.7. Give different values to the factors which enter the equation and repeat the above steps. At last we can obtain the best assignment:age (≥40years、<40years:0、1), course of disease (≥1year,6months-1year,≤6months:0、1、2), anamnesis (no anamnesis、 have the history of hypertension or thyroid diseases or mammary gland:0、1), echo structure (Cystic or Cystic and solid、solid:0、3), margins (defined、ill-defined:0、3), shape (regular、irregular:0、4), calcification type (no calcification、macro-calcification、 micro-calcification:0、2、4), echo intensity (equal or high level、low level:0、4)， blood (not rich、rich:0、3), size(≥1cm:0、1),family history (have family history、have no family history:0、1) and occupation(have no job、have a job:0、1), lymph gland (normal、abnormal:0、1), the total point is a more simple method as a diagnosis,the diagnostic cut-off point is9.5, the diagnostic sensitivity and specificity were75%and75%。... |
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