Value Of TI-RADS Combined With Color Flow Imaging In Differential Diagnosis Of Thyroid Nodules

Thyroid nodules is common clinical disease, malignant nodules' incidence is still increasing annually, and has become the fastest growing incidence cancer. Ultrasound is the preferred method of auxiliary examination of thyroid nodules. Thyroid imaging reporting and data system(TI-RADS) which established on the basis of utilization many benign and malignant thyroid nodules' specific ultrasound findings, could grade malignant tendency of thyroid nodules. Our study was to investigate the diagnostic value of TI-RADS and supplemented by color flow imaging to differential diagnosis of benign and malignant thyroid nodules and then compared Compare their diagnostic Effectiveness. Color flow imaging technology includes enforced flow imaging(e-Flow) and color flow imaging Doppler(CDFI). Diagnostic value of these two color flow imaging technology are also discussed in this study.The study included 257 thyroid nodules, all cases were prepared for thyroid surgery in the Department of Otolaryngology Head and Neck Surgery of the First Affiliated Hospital of Hebei North University from June 2014 to August 2015. All cases were underwent thyroid ultrasound examination before surgery and Ultrasound results were all recorded and graded. Pathology results were the gold standard of differential diagnosis of thyroid nodules. SPSS 17.0 statistical software was for statistical analysis. ROC curve was used to compare the diagnostic value of TI-RADS and diagnostic Value of CDFI and e-Flow. The sensitivity, specificity and accuracy was for diagnostic Effectiveness comparison between TI-RADS and which combined with CDFI or e-Flow; Chi-square test was used to comparison between two groups, and P<0.05 was considered as statistically significant.The results of this study showed that:(1) pathological findings of 257 thyroid nodules is 71 malignant and 186 benign;(2) there were differences ultrasound findings on shape, aspect ratio, boundary, internal echo, micro-calcification and cervical lymph nodes abnormality, and the difference was statistically significant(P < 0.01);(3) The TI-RADS accuracy of Horvath etc in thyroid nodules differential diagnosis is lower, which of Park etc, Kwak etc, Russ etc and Zhang Zhengshun etc is moderate. The area under the ROC curve were as follows: AUCHorvath =0.695±0.036(P<0.01, 95%CI 0.625~0.766); AUCPark=0.799±0.035(P<0.01, 95%CI 0.731~0.868); AUCKwak =0.741±0.037(P<0.01, 95%CI 0.669~0.813);AUCRuss=0.755 ±0.036(P<0.01, 95%CI 0.684~0.826); AUC Zhang=0.746±0.034(P<0.01, 95%CI 0.678~0.813);(4) diagnostic value of color flow imaging comparison between e-Flow and CDFI showed that e-Flow is higher, The area under the ROC curve were AUCCDFI =0.614±0.037(P < 0.01, 95%CI 0.540~0.687); AUCe-Flow=0.760±0.038(P<0.01, 95%CI 0.686~0.834);(5) Compared with TI-RADS, there is higher sensitivity when TI-RADS combined with e-Flow for the differential diagnosis of benign and malignant thyroid nodules(?2Park-TI-RADS+e-Flow=29.316,P<0.01; ?2Kwak-TI-RADS+e-Flow=4.708, P<0.05).(6) In pathological results as the gold standard diagnostic tests of consistency check, the consistency of TI-RADS combined with e-Flow is better than which of TI-RADS or TI-RADS combined with CDFI( in Parke etc. TI-RADS: Kappa TI-RADS=0.364, P<0.01; Kappa TI-RADS+CDFI = 0.248, P < 0.01; Kappa TI-RADS+e-Flow=0.589, P < 0.01; in Kwak etc. TI-RADS: Kappa TI-RADS=0.167, P<0.05; Kappa TI-RADS+CDFI=0.109, P<0.05; Kappa TI-RADS+e-Flow=0.209, P<0.01)To summary up, in the differential diagnosis of thyroid nodules, Shape, aspect ratio, boundary, echo nodules, micro-calcification and cervical lymph nodes abnormality are important specific ultrasound features; there is good value of TI-RADS in thyroid nodules' differential diagnosis; e-Flow is better than CDFI in color flow imaging of thyroid nodules; Combined with e-Flow, TI-RADS can improve the sensitivity and consistency of the differential diagnosis of thyroid nodules.