Application Of Ultrasonic Technology In Focal Thyroiditis And Thyroid Microcarcinoma In Differential Diagnosis

Objective:Comparative study of conventional ultrasound, ultrasound elasticityimaging technology, ultrasound guided under the application of fineneedle aspiration cytology in focal thyroiditis and thyroidmicrocarcinoma in differential diagnosis.To investigate the differentialdiagnostic value of ultrasonography on different focal thyroiditis andthyroid microcarcinoma.Methods:Retrospective analysis between October2012and January2012of128patients in our hospital at128tiny lesions（≤1cm）,surrounding thefocus background were normal thyroid parenchyma, both theconventional ultrasound、real-time ultrasound elasticity imaging andultrasound guided needle biopsy cytology,then a detailed record the mainobservation indexes.The postoperative pathological or tissue biopsyresults as the gold standard, draw the receiver-operating characteristiccurve,calculate area under the curve,according to the optimal diagnosticcritical point Youden index to determine the SR,and for the ultrasonicdiagnosis index of single factor analysis, comparing the focal thyroiditisand thyroid carcinoma differences in two groups of patients,Using weighted Kappa coefficient of ultrasound to determine the differentdiagnostic methods and pathological findings of consistency,for the bestdiagnosis method.Results:(1) Conventional ultrasound for focal thyroiditis and thyroidmicrocarcinoma identification,the sensitivity was54.84%,specificity of91.75%,accuracy was82.81%,the positive predictive value was68%, thenegative predictive value was86.41%.(2) Ultrasonic elastic strain rate measured by the ratio of focalthyroiditis SR was1.96±0.42,SR of thyroid carcinoma was3.14±0.57,theSR of thyroid carcinoma was obviously higher than that of focalthyroiditis,by t test,both have significant difference(P <0.001).Controlpathological findings,draw the ROC curve,AUC was0.828±0.058, the95%confidence interval of0.715～0.942, the maximum cut-off valueaccording to the Youden index, to determine the critical point of2.29isthe best diagnosis.Ultrasonic elastic strain rate measured for focalthyroiditis and thyroid microcarcinoma identification,the sensitivity was67.74%,specificity of87.63%,accuracy was75%,the positive predictivevalue was63.64%, the negative predictive value was89.47%.(3) Ultrasound guided fine needle aspiration for focal thyroiditis andthyroid microcarcinoma identification,sensitivity of90.32%,specificity of98.97%,the accuracy was96.88%,positive predictive value was 96.55%,negative predictive value of96.97%.(4) With pathologic results as the gold standard,three methods ofdiagnosis by using weighted Kappa coefficient is analyzed,the resultsshow that the Kappa value was0.5196,0.7609,0.9130,conformancestatement three examination methods on focal thyroiditis and thyroidmicrocarcinoma differential diagnosis and pathologic results from high tolow as ultrasound guided fine needle aspiration>elastography strain rateratio method>conventional ultrasound.Conclusions:(1) Conventional ultrasound is based in the small lesions of thyroid,ultrasound elasticity imaging technique is a useful supplement. Ultrasonicelastography strain rate ratio method in semiquantitative way objectivelyreflect the relative hardness of tiny lesions in the thyroid,has a highdiagnostic value.(2) Ultrasound guided fine needle biopsy cytology can fast accuratedifferential diagnosis of thyroid small lesions, is the first choice forpreoperative screening and differential diagnosis,for the preoperativediagnosis, provides an objective basis for correct selection of surgical, toavoid the unnecessary surgery in patients with benign lesions.(3) Conventional ultrasound、ultrasound elasticity imaging and strainrate examination of fine needle aspiration cytology ratio method and threeultrasound-guided technique combined with application of qualitative to small lesions in the thyroid is very important.