The Diagnostic Value Of Combination Of TI-RADS And Three-dimensional Shear Wave Elastography In The Differentiation Of Benign And Malignant Thyroid Nodules

Objective:To evaluate the diagnostic value of thyroid imaging-reporting and data system(TI-RADS)combination of three-dimensional(3D)shear wave elastography(SWE)in the differentiation of benign and malignant thyroid nodules.Materials and Methods:Review the data of 26 patients with 32 thyroid nodules from August 2017 to February 2018.All patients were examed by gray-scale ultrasonography,2D-SWE and 3D-SWE before operation.All nodules were evaluated by TI-RADS which was suggested by Kwak.Pathologic results were used as diagnostic criteria,and calculated the threshold(3D-SWE)between benign and malignant nodules.Then,combined 3D-SWE with TI-RADS diagnostic system.Diagnostic efficacy was compared before and after adjustment.Result:1.Pathology showed that out of 32 nodules,24 were benign and 8 were malignant(5 papillary carcinomas,3micropapillary carcinomas).The AUC of TI-RADS diagnosis system was 0.84,the sensitivity was 75% and the specificity was 83.3%.2.E-mean between benign and malignant in 2D-SWE was 35.6?17.8KPa,53.4 ? 20.9KPa;E-mean between benign and malignant in 3D-SWE was41.5?13.7KPa,67.4?17.1KPa.E-mean in malignant nodules was significantly higher than E-mean in benign,whether 2D-SWE or 3D-SWE.At the same time,E-mean of 3D-SWE was higher than 2D(48.0?18.3KPa,35.6?17.8KPa;P<0.05).The AUC,sensitivity,specificity for 2D-SWE were as follows: 0.83,75%,91.7%,46.9KPa,and the AUC,sensitivity,specificity for 3D-SWE respectively were: 0.8775%,91.7%,63.3KPa.And there was no differencebetween them in AUC(z=1.128,P>0.05).3.The AUC of combined TI-RADS/3D-SWE was 0.85,sensitivity was75%,and specificity was 91.6%.The AUC for combined TI-RADS/3D-SWE was not different from TI-RADS only(P>0.05)as well as sensitivity,specificity and misdiagnostic rate.However,the rate of missed diagnosis can be reduced by combination(P<0.05).Conclusion:1.TI-RADS functions better in helping evaluate the malignant risk of thyroid nodules and guide surgeons.2.Both 3D-SWE and 2D-SWE have efficient diagnostic value for thyroid nodules,and they share the similar diagnostic effects.3.There is no difference between combined TI-RADS/3D-SWE and TI-RADS only in diagnosing benign or malignant nodules,but combined diagnosis can reduced the missed diagnosed patients.