The Diagnostic Value Of Shear Wave Elastography And American Thyroid Association In 2015 On Thyroid Nodules

Background and Objective With the development of high frequency ultrasound diagnosis technology,the rate of thyroid nodules detected increases,data show that in the random people,the detecting rate of thyroid nodules was 19%-67%,and the rate of thyroid cancer detected was 5%-10%.In order to standardize diagnosis and treatment of thyroid disease in 2015,the American Thyroid Association(American Thyroid Association ATA),issued an new guideline.The sonographic features of thyroid nodules due to the different risk coefficient is divided into five different groups as follows: 1,benign(< 1%);2,very low suspected malignant group(< 3%);3,low-grade suspicious malignant group(5%~10%);4,moderate suspicious malignant group(10%~20%),5 highly suspected malignant group(70%~90%).The characteristics of nodules in the ATA guidelines that was not described are split up into “Not described group”.very low,low,moderate,highly suspected malignant group are recommended performing fine-needle aspiration(fine-needle,aspiration,FNA)of benign and malignant thyroid biopsy.For the ultrasound image characteristics of benign and malignant thyroid nodules are crossing and coincident,and the ultrasound doctors diagnosis experience differently,the same nodules may be diagnosed into different risk categories,some benign nodules was spilt into a higher risk category,and performed the biopsy;and some malignant nodules with low risk categories,failed to FNA,which leaded an delay in treatment.The low malignant group suspected malignant risk is extremely low,mostly is benign nodules,and the risk of suspected malignant group of malignant is high,mostly malignant.The risk of low-grade malignant group,moderate risk of malignancy suspected malignant group is relatively low,most nodules are benign nodules.So we need to some other examination methods to further differentiate malignant nodules from negative nodules.Shear wave elastography can quantitatively evaluate on the classification of benign and malignant thyroid nodules.This study aims to investigate the clinical diagnose value of the shear wave imaging technology,2015 edition ATA combined with shear wave elastography in benign and malignant thyroid nodules,to investigate if the SWE imaging technology can help improve the diagnostic efficiency of the ATA guidelines for the diagnosis of thyroid nodules,decrease the rate of some benign nodules performed FNA biopsy,so that FNA is more objective when using ATAMaterials and Methods 1.The 1 part,collecting 175 cases of thyroid nodule that detected by ultrasound from October 2015 to September 2016 in our hospital.Taken pathology after operation as the gold standard.and the nodules underwent shear wave elastography,and measured the Young modulus of each nodule,ROC curve was drawn,through the area under the ROC curve,we evaluate the value of young's modulus in the diagnosis of thyroid nodules,and reference boundary value analysis identificating of benign and malignant lesions.2.The 2 part,evaluation of the 2015 ATA edition in the diagnosis value of benign and malignant thyroid nodules.Regarding the very low suspected malignant group as benign,low suspected malignant group and above as malignant.Figuring out the diagnostic sensitivity specificity and accuracy of the 2015 edition of the ATA guidelines of thyroid nodules;with nodules maximum Young's modulus of 53.53 Kpa as a diagnostic value.When the young's modulus maximum> reference boundary,low to moderate suspected malignant group and “not described” group was regarded as malignant,and the young's modulus maximum? reference boundary,low to moderate suspected malignant group and “not described” group was regarded as Benign.Compare the differences between two methods of sensitivity,specificity and accuracy,after the application of SWE Technology.Results: 1.Of 175 cases of nodules in study,82 cases of benign nodules,93 cases of malignant nodules,The maximum Young's modulus of Benign lesion group was 39.94±24.45 Kpa,and the malignant lesion group was 79.91±31.79 Kpa,Between different groups,the difference was statistically significant(P < 0.05).Draw the ROC curve of the maximum values of Young's modulus,the AUC of the maximum Young's modulus in the diagnosis of thyroid malignant nodules was 0.821.the diagnostic sensitivity was 90.32%,the specificity was 80.49%,accuracy was 85.71%.2.When the ATA was in the diagnosis of thyroid malignant nodules,the sensitivity was 98.92%,specificity was32.93%,and accuracy was 68.00%;When SWE is applied to ATA,the sensitivity in the diagnosis of thyroid malignant nodules was 97.85%,the specificity was 79.36%,and the accuracy was 89.14%.The comparison between methods in the diagnosis of malignant lesions of thyroid nodules was ?2 test.The differences of sensitivity between two methods was not statistically significant(P > 0.05).The differences of specificity,accuracy between methods was statistically significant(P < 0.05).Conclusion: 1.Shear wave elastography could quantitatively evaluate thyroid tissue hardness,and the maximum Young's modulus of nodules was 53.53 Kpa as a diagnostic value.2.For identification of the benign and malignant thyroid nodules,combining the SWE technology with the edition of 2015 ATA guidelines can improve the specificity and accuracy,While not reduce sensitivity,which can be more targeted to the nodules of FNA puncture.