Clinical Value Of Modified TI-RADS Classification Of Thyroid Nodules By Shear-wave Elastography Combined With Micropure Imaging Technology

Part 1 Diagnostic value of Shear-wave Elastography in benign and malignant thyroid nodulesObjectives To explore the diagnostic value of maximum Young's modulus in shear wave elastography for benign and malignant thyroid nodules and to determine the optimal diagnostic threshold.Methods 116 thyroid nodules of 107 patients were collected in Our Hospital which were confirmed by Operation or fine needle aspiration cytology under Ultrasound Guidance.Using TOSHIBA Aplio 500 color Doppler ultrasonography,Ultrasound physicians with more than 8 year's working experience examined the thyroid nodules by traditional ultrasonography and measured the maximum Young's modulus by SWE,Repeated measurements of the same nodule were made three times,and the average number was obtained.Taking the pathological results as the gold standard and using independent sample T-test,when P<0.05,the ROC curve was drawn,the maximum of specificity+sensitivity-1 was calculated to determine the optimal diagnostic threshold of SWE.Results The maximum Young's modulus of benign thyroid nodules was 34.4±12.5kPa and that of malignant thyroid nodules was 56.7±25.4kPa.There was a significant difference between them(t=6.31,P<0.05).The area under ROC curve(AUC)was 0.802,and the optimal threshold for the diagnosis of benign and malignant thyroid nodules was 47.7 kPa.Conclusion Shear-wave Elastography has differential diagnostic value for benign and malignant thyroid nodules.The optimal diagnostic threshold of maximum Young's modulus is 47.7kPa.Part 2 Clinical value of modified TI-RADS classification of thyroid nodules by Shear-wave Elastography combined with Micropure imaging technologyObjectives The application of Shear-wave Elastography(SWE)combined with Micropure imaging technology improves the accuracy of classification diagnosis of thyroid nodules,thus reducing the number of ultrasound-guided fine needle aspiration biopsy(US-FNAB).Methods Conventional ultrasound used Kwak TI-RADS classification standard,SWE combined with MicroPure imaging to improve the classification of thyroid TI-RADS.Referring to the expert consensus and operating guideline of ultrasound-guided fine needle aspiration biopsy of thyroid nodules(2018 edition),clinical suspected TI-RADS4 nodules were selected as the object of ultrasound-guided fine needle aspiration biopsy(US-FNAB),and that as the US-FNAB group,the number of US-FNAB group and non-US-FNAB group before and after improved TI-RADS classification was cross-tabulated for chi-square test,When P<0.05,there was significant difference between the two groups.The sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate of diagnosis before and after improved classification were calculated and compared according to the pathological results.Results The number of US-FNAB in TI-RADS classification after improved SWE combined with MicroPure imaging was less than that in Kwak classification,and the difference was statistically significant(?2=4.77,P<0.05),The sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate of Kwak classification and SWE combined with MicroPure imaging were 93.5%,60.5%82.9%,82.1%,82.7;94.1%,75.0%,84.2%,90.0%,86.2%,respectively.Conclusion Improvement of TI-RADS classification of thyroid nodules by SWE combined with Micropure imaging technology can improve the accuracy of diagnosis and reduce the number of US-FNAB,which has clinical practical value.