Application Of Multimodality Diagnosis For Thyroid Nodule

Objective: To explore the application value of multimodality diagnosis,which including thyroid imaging reporting and data system(TI-RADS),shear wave elastrography(SWE),ultrasound-guided fine needle aspiration(US-FNA)and detection of BRAF V600 E,in diagnosis benign and malignant thyroid nodules.Method: 373 thyroid nodules from 349 patients who underwent ultrasound-guided fine-needle aspiration(US-FNA)from March 2016 to January 2018 were collected.Before the US-FNA,thyroid nodules were classified into groups according to TI-RADS,and the Emax of SWE were recorded.Some samples from FNA were used in the conventional smear and the results were analyzed with Bethesda classification system,the latter samples were conducted with detect the mutation of BRAF V600 E.The patients who received operative treatment were follow-up.Then the results of TI-RADS,SWE,FNA and the mutation of BRAF V600 E with histopathology were analyzed comparatively.Results:(1)For the 373 nodules,there were differences of TI-RADS,SWE Emax of elastic modulus,the mutation of BRAF V600 E between Bethesda II and VI(P=0.000).(2)Among 209 operative nodules,there were 201 malignant nodules and 8 benign nodules.The sensitivity,specificity,positive and negative predictive value,accuracy were 78.11%,50.00%,97.51%,8.33% and 77.03% respectively.For the SWE Emax of elastic modulus,malignant nodules were higher than benign ones.The best diagnostic threshold of Emax was 48.65 kPa.TI-RADS combined with Emax measurement could increase sensitivity,specificity,positive and negative predictive value,accuracy to 95.52%,75.00%,98.96%,40.00% and 94.73% respectively.All nodules that had gene BRAF V600 E mutation were papillary thyroid carcinoma.FNA combined with the mutation of BRAF V600 E could identify 98.51% malignant nodules.Multimodal diagnosis of TI-RADS,SWE,FNA and gene BRAF V600 E,sensitivity and accuracy was 100% and 97.61% respectively.(3)Among 49 indeterminate nodules,97.50% Bethesda V nodules were malignant.Results show that sensitivity of mutation of BRAF V600 E was 55.82%.Conclusion:(1)The statistical differences of SWE Emax could be found between malignant and benign thyroid nodule.The Emax of malignant thyroid nodule was higher than benign ones,and the best value for diagnosis was 48.65 kPa.TI-RADS which combined with SWE could improve sensitivity toward malignant nodules.(2)Result of FNA showed that there were high rate of malignant in Bethesda V/VI nodule,the positive predictive value reached 98.96%,surgical management could be recommended.(3)All nodules that had gene BRAF V600 E mutation were papillary thyroid carcinoma.There were no BRAF V600 E mutation in benign nodules and the specificity was 100%.If nodules had gene BRAF V600 E mutation,surgical management could be recommended.(4)The multimodality diagnosis,which including TI-RADS,SWE,FNAand detection of BRAF V600 E,could improve the accuracy of differentiating benign and malignant nodules.and has the maximized guideline values of clinical treatment.