| Objective:1.To explore the clinical value of ultrasound-guided fine needle aspiration cytology and conventional ultrasound evaluation of thyroid nodules,and to compare the diagnostic value of US-FNAC for nodules of different diameters.2.To investigate the fine needle aspiration(FNA)in the thyroid imaging reporting and data system(thyroid imaging reporting and Data system,TI-RADS)The value of the differential diagnosis of benign and malignant nodules of type 3 and 4,further improve the clinical TI-RADS classification of thyroid nodules.3.To analyze the clinical and pathological features of patients with thyroid nodules,to explore the risk factors associated with malignant thyroid nodules,and to assist in the diagnosis of thyroid nodules.Methods:Retrospective analysis of 121 cases of thyroid nodules in the Department of Breast Surgery,the First Affiliated Hospital of University of South China from January 2018 to January 2019.All patients underwent CUS,US-FNAC,serum thyroid function tests,and Surgical treatment,the nature of the nodules was based on the post-operative histopathological results as the gold standard,and the following comparisons were made:1.Compare the sensitivity,specificity,diagnostic accuracy,false positive rate,and false negative rate of the diagnosis of benign and malignant thyroid nodules by CUS and US-FNAC respectively.Further compare US-FNAC to thyroid nodules≤10mm and>10mm Diagnostic efficacy.2.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of FNA cytological diagnosis of TI-RADS type3 and 4a nodules were calculated byχ~2 test.The difference was statistically significant at P<0.05.3.According to the postoperative histopathological results,they were divided into two groups:benign group(benign nodules)in 35 cases,malignant group(malignant nodules)in 86 cases.Univariate analysis of age,sex,serum thyroglobulin antibody(TgAb),thyrotropin(TSH),free thyroxine(FT4),free triiodothyronine(FT3)levels,the FT4/FT3ratio,which the results were compared,and then multivariate logistic regression analysis was used to screen the risk factors of malignant thyroid nodules.Results:1.US-FNAC diagnosed 100 cases of positive nodules(79 cases of malignant nodules+21 cases of suspected malignancy);21 cases of negative nodules(18 cases of benign nodules+atypia of undetermined significance(AUS)3 cases);its accuracy,sensitivity,specificity,false positive rate,false negative rate are:85.9%(103/121),97.7%(84/86),54.3%(19/35),45.7%(16/35),2.3%(2/86).Ultrasound was evaluated as positive nodules in 101 cases and negative nodules in 20 cases.The accuracy,sensitivity,specificity,false positive rate and false negative rate were 69.4%(84/121)and 87.2%(75/86),respectively.25.7%(9/35),74.3%(26/35),12.8%(11/86);The accuracy and sensitivity of US-FNAC were higher than those of ordinary ultrasound,and the false negative rate was relatively low,and the difference was statistically significant(P<0.05).The specificity,negative predictive value and diagnostic compliance of US-FNAC between the nodules≤10mm and>10mm were statistically significant(P<0.05).2.In this study,there were 22 cases of TI-RADS type 3 nodules.The results of FNA cytology diagnosis were positive nodules in 12 cases,negative nodules in 10 cases,and TI-RADS 4a type in 84 cases.The FNA cytological diagnosis results in positive nodules.73 cases,11 cases of negative nodules;compared with postoperative pathological results(3categories:malignant 12 cases+benign 10 cases;4a:malignant 61 cases+benign 23 cases),the difference was statistically significant(P<0.0.05).The sensitivity,specificity,accuracy,and actual malignancy of US-FNAC diagnosis were 83.3%,80.0%,81.8%,and 54.5%of TI-RADS type 3 nodules,respectively;TI-RADS type 4a nodules:sensitivity,specificity,Accuracy and actual malignancy were 78.1%,90.9%,79.8%,and 72.6%,respectively.In the diagnosis of malignant nodules,US-FNAC’s diagnostic assessment of TI-RADS Class 3 nodules is more accurate and sensitive than TI-RADS Type 4a nodules.3.Univariate analysis showed that the age,TgAb,TSH and FT4/FT3ratios of the benign and malignant groups were statistically different(P<0.05).Multivariate logistic regression analysis showed that age and TgAb levels were independent risk factors for malignant thyroid nodules(P<0.05).Conclusion:1.US-FNAC identifies the nature of thyroid nodules with higher accuracy than conventional ultrasound.2.The age,serum TSH,TgAb,FT4/FT3 ratio of patients with thyroid nodules may have a higher diagnostic value for the identification of thyroid nodules.3.US-FNAC has a high diagnostic efficiency for the benign and malignant determination of TI-RADS 3,4a nodules,which is beneficial to reduce the underestimation of TI-RADS 3,4a nodules. |
