Application Of The Maximum Value Of Young's Modulus Of Real-time Shear Wave Elastography In Differential Diagnosis Of Benign And Malignant Thyroid Nodules

Objective:The purpose of this study was to access the application value of the maximum value of the young's modulus(Emax)of real-time shear wave(SWE)elastography in differential diagnosis of benign and malignant thyroid nodules.Methods:We used the linear array probe(L15-4)of Supersonic Imagine Aixplorer color doppler ultrasonic diagnostic instrument in our study.Conventional ultrasound was applied to 297 thyroid nodules(from 252patients)to observe their size,shape,internal echo,margin,aspect ratio,calcification,peripheral and internal blood flow,with or without lymph node metastasis.Thyroid nodules were classified into groups according to thyroid imaging data reporting and scoring system(TI-RADS),and then undergone shear wave ealstography and the young's modulus was recorded.According to pathological results,the log normal distribution model was used to fit the Emax of benign and malignant thyroid nodules.And then according to the statistical value of Emax value and 95%probability value,the value range of Emax in the differential diagnosis of thyroid nodules was obtained.And the specificity and sensitivity of the value range for benign and malignant thyroid nodules were calculated.The 186 thyroid nodules of TI-RADS 3-4 categories were classified into two groups to analyze the application value of Emax in each group:group ?,diameter less than or equal to 10 millimeter;group ?,diameter greater than 10 millimeter.All the nodules were confirmed by pathology.ROC curve was drawn to evaluate sensitivity,accuracy and specificity.of Emax in group ? and group ?.Result:Emax<45kPa,the possibility of benign thyroid nodules is higher than that of malignant nodules,approximately 50%of which are benign;45 kPa?Emax<70 kPa,thyroid nodules are suspicious lesions;70 kPa?Emax<120 kPa,thyroid nodules are suspicious malignant,and the probability of malignant nodules within this interval is greater than 50%;Emax?120 kPa,The thyroid nodules are highly suspicious of malignancy,and the possibility of benign nodules is less than 5%.Among them,31%benign thyroid nodules and 37%malignant nodules can not directly diagnose the benign and malignant nodules by Emax.The specificity of the benign thyroid nodules was 78%,the false negative rate of which was 22%;and the sensitivity of thyroid malignant nodules was about 76%,the false positive rate of which was about 24%.The cut-off point for the maxim value of Young's modulus was 52.5kPa,the accuracy,sensitivity and specificity value in group ? and group ? were 66.2%,57.4%or 90%,and 79.5%,87.5%or 68.8%,respectively.The area under the curve(AUC)in group ? and group ? was 0.81 and 0.842,respectively.Conclusion:The maximum value of the young's modulus of real-time shear wave elastography was significant in differentiating benign and malignant thyroid lesions,and had a high clinical value in evaluating the risk of benign and malignant thyroid nodules.In group ? and ?,SWE play more important role in differentiating thyroid nodules whose diameter greater than 10 millimeter.While in group ?,the value of SWE was limited.Such patients should be combined with other related tests to confirm the diagnosis as soon as possible.