Qualitative Study Of Contrast-Enhanced Ultrasound In Benign And Malignant Thyroid Nodules

Part 1 Qualitative analysis of CEUS in benign and malignant thyroid nodules with different sizes Objective: To explore the value of qualitative analysis of contrast-enhanced ultrasound(CEUS)in diagnosis of benign and malignant thyroid nodules(TNs)with different sizes.Methods: 329 TNs in 255 patients who had undergone CEUS in the First People’s Hospital,School of medicine,Shanghai JiaoTong University were included,mean age,48.0 ±12.6 years;age range,15~81 years;mean size,1.29 ±0.82cm;size range,0.5~4.7 cm.Inclusion criteria:(1)TNs were diagnosed as solid by conventional ultrasound;(2)TNs were confirmed by FNAB or thyroid surgery.Exclusion criteria:(1)TNs were diagnosed as cystic or cystic solid by conventional ultrasound;(2)FNAB is indefinite or no surgical pathological;(3)contrast agent allergy,severe cardiopulmonary dysfunction,pregnant and lactating women,patients under 18 years old.According to the maximum length(ML)of TNs,TNs were divided into small size group(ML≤1cm,n=166)and large size group(ML>1cm,n=163).CEUS characteristics were compared with chi-square test between benign and malignant TNs in the two groups.CEUS characteristics were assigned scores,and ROC curve was performed to evaluate the diagnostic efficacy of these scores in diagnosis of benign and malignant TNs with different sizes.Results: In the small size group,there were significant differences in the degree,patterns of enhancement,boundary,shape and homogeneity of enhancement between benign and malignant TNs(P<0.05).In the large size group,there were significant differences in the degree,patterns of enhancement,boundary,shape and homogeneity of enhancement,completeness of enhancement,size of the enhanced lesions between benign and malignant TNs(P<0.05).In small size group,taking 3.5 points as the cut off value,AUC of ROC curve was 0.889(P<0.001),and the sensitivity、specificity、accuracy was 77.90%、84.06%、78.66% respectively.In large size group,taking 2.5 points as the cut off value,AUC was 0.910(P<0.001),and the sensitivity、specificity、accuracy was 90.40%、76.60%、81.13% respectively.Conclusion: Qualitative analysis of CEUS has high value in differential diagnosis of benign and malignant TNs with different sizes.The sensitivity and accuracy of CEUS in the large size group were higher than in the small size group,and the specificity in the large size group were lower than in the small size group.The ability of CEUS in the diagnosis of thyroid nodules of different sizes was emphasized.Part 2 Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of benign and malignant thyroid TR3~5 small nodules(less than 1cm)Objective: To evaluate the performance of contrast enhanced ultrasound in the diagnosis of benign and malignant thyroid TR3~5 solid small nodules(≤1cm).Methods: From January 2016 to March 2018,185 TNS in 154 patients who underwent CEUS in the First People’s Hospital,School of medicine,Shanghai Jiao Tong University,with an average age of 48.7±12.8(25-80)years.Inclusive criteria:(1)All nodules were diagnosed as solid nodules by conventional ultrasound;(2)All nodules had a longest diameter of less than 1 cm;(3)All nodules were confirmed by surgical pathology or FNAB.Exclusive criteria:(1)nodules were diagnosed as cystic or solid-cystic by conventional ultrasound;(2)FNAB diagnosis was unclear or no surgical pathology results.(3)Severe cardiopulmonary dysfunction,contrast agent allergy,pregnant women and lactating women,patients under 18 years old.All patients received and signed informed consent before CEUS.CEUS characteristics of thyroid small solid nodules between benign and malignant were compared with chi-square test,CEUS characteristics of malignant nodules were assigned scores.The total score of the contrast-enhanced features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System(TI-RADS)published by the American College of Radiology(ACR),the ROC curves for identifying benign and malignant nodules of the thyroid were drawn and the diagnostic performance of the two was compared.Results: There were significant differences in the degree,patterns of enhancement,boundary,shape and homogeneity of enhancement in thyroid small solid nodules.(P<0.05),were not significantly differently between benign and malignant TNs in completeness of enhancement and size of the enhanced lesions(P>0.05).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of ACR TI-RADS classification TR5 for the diagnosis of malignant nodules were: 90.10%,55.95%,74.59%,72.22%,and 82.46% respectively.The area under the curve is 0.738(95% confidence interval 0.663 to 0.813).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 86.13%,89.29%,87.57%,90.63% and 84.27% respectively.The area under the curve is 0.916(95% confidence interval 0.871 to 0.961).Conclusion: The diagnostic performance of thyroid solid nodules is better than that of ACR TI-RADS.Qualitative analysis of contrast-enhanced ultrasound has a significantly higher specificity for the diagnosis of thyroid malignant nodules than ACR TI-RADS.Qualitative analysis of contrast-enhanced ultrasound has a high value in the diagnosis of malignant thyroid nodules.