Value Of TI-RADS Combined With Serum TSH In The Diagnosis Of 4 Types Of Thyroid Nodules

Objective: To investigate the diagnostic value of ultrasound thyroid imaging report and data system(TI-RADS)combined with preoperative serum thyrotropin(TSH)examination for TI-RADS 4thyroid nodules and the auxiliary diagnosis value of serum TSH level as an ultrasound diagnosis for thyroid nodules.Methods: A retrospective analysis was performed on 241 patients with thyroid nodules diagnosed as TI-RADS 4.The clinical data of the patients were collected,including age,gender,preoperative serum TSH value.The image features of ultrasound analysis of nodules were analyzed,including the nodule size,nature,echo,border,calcification,aspect ratio,etc.The correlation between preoperative serum TSH and thyroid nodules was analyzed with pathological diagnosis as the gold standard.The receive operating characteristic(ROC)was used to compare the diagnostic value of TI-RADS combined with serum TSH for 4 type thyroid nodules,and the area under curve(AUC)was compared to calculate the sensitivity,specificity,accuracy,and positive predictive value,and negative predictive value between the two.Results: Of the 241 patients with thyroid nodules,198 are female,43 are male,57 have 4a nodules,138 have 4b nodules,and 46 have 4c nodules.The pathological results show that 84 cases are benign nodules,including 48 nodular goiters,11 adenomatic nodular goiters,6 chronic lymphocytic goiteritis,7 nodular goiters with cystic degeneration,8 nodular goiter with granulomatous inflammation,3 follicular adenoma,and 1 microcystic papillary tumor;157 cases are malignant nodules,all of which are thyroid papillary carcinoma(PTC).The calculation shows that preoperative serum TSH level in benign nodule group is(1.73 ± 1.00)mIU / L;and preoperative serum TSH level in groups of malignant nodules is(2.43 ± 1.07)mIU / L.The differences in serum TSH levels between benign and malignant nodules are ofstatistical significance(p<0.001).The area under the ROC curve for TSH diagnosis of malignant thyroid nodules(TI-RADS 4)is 0.698(p<0.001),and its optimal cut-off value is 1.848 mIU / L,the sensitivity is 73.9%,the specificity is 64.3%,the accuracy is 70.8%,the negative predictive value is 56.8%,and the positive predictive value is 79.5%;the sensitivity,specificity,accuracy,negative predictive value,and positive predictive value of the TI-RADSdiagnosis of malignant thyroid nodules(TI-RADS 4)are90.4%,50.0%,76.3 %,73.7% and 77.2% respectively;for TI-RADS combined with TSH diagnosis of malignant thyroid nodules(TI-RADS 4),the sensitivity,specificity,accuracy,negative predictive value,and positive predictive value are73.9%,90.5%,79.7%,65.0% and 93.5%respectively.Conclusions: The preoperative TSH examination has certain value in identifying the properties of TI-RADS 4 thyroid nodules.TI-RADS combined with TSH examination can improve the diagnostic accuracy and specificity of TI-RADS 4 thyroid nodules.