Explore The Value Of TI-RADS Classification In The Diagnosis And Treatment Of Thyroid Nodules

OBJECTIVE:To retrospectively analyze the ultrasound data and pathological examination results of patients with thyroid nodules admitted in our hospital.We made use of the Thyroid Imaging Reporting and Data System(TI-RADS)to diagnose thyroid nodules of patients,and wanted to know whether the classification system has universal applicability and practicality in the diagnosis and treatment of benign and malignant thyroid nodules.So that we could provide more accurate diagnostic strategies and treatment plans for patients with thyroid nodules through the results of the system.Methods:A total of 214 patients with thyroid nodules who were treated in our hospital from July 2018 to July 2019 were selected,and strict inclusion and exclusion standards were established.We selected 302 thyroid nodules that met the requirements from all of them.The ultrasound characteristics of selected nodules were retrospectively analyzed,and all were classified by using the TI-RADS standard.We compared the benign and malignant judgments of postoperative pathological results,and observed the diagnostic efficacy of TI-RADS classification of different nodules' ultrasound images.SPSS software was used for statistical analysis.Univariate analysis was performed on the components,echo,morphology,boundary,microcalcification,aspect ratio,blood flow and other signs of each nodule,and Logistic regression analysis was performed for statistically significant variables(P<0.05).The postoperative pathological results of thyroid nodules were regarded as the gold standard.We planned to construct a receiver operating characteristic curve(ROC),and recorded the TI-RADS classification system's area under the curve(AUC),accuracy,sensitivity,andspecificity,etc.,so as to analyze the correlation between different assessment signs and the degree of nodular malignancy risk in the TI-RADS classification.Results:A total of 214 patients with 302 nodules were collected in this study,including 126 patients with 1 nodule and 88 patients with 2 nodules.And there were 182 benign nodules and 120 malignant nodules,including 177 nodules of type TI-RADS 2 ? 3,61 of type 4a,52 of type 4b,10 of type 4c,2 of type 5.And the results showed that their malignant rates were 14.1%,60.7%,88.5%,100.0% and 100.0%.With the higher TI-RADS grade,the incidence of malignant nodules are gradually increased.Using TI-RADS 4a as the cut-off point,the accuracy,specificity,sensitivity,positive predictive value,and negative predictive value of TI-RADS classification for benign and malignant thyroid nodules were calculated to be 81.8%,83.5%,79.2%,76.0%,and 85.9%respectively.Based on the gold standard of postoperative pathological results,the ROC curve of TI-RADS classification was drawn.The area under the curve was 0.842,the standard error was 0.025,P <0.001,and the 95%confidence interval was 0.792-0.891.Benign and malignant thyroid nodules were significantly different in composition,echo,morphology,borders,microcalcification,aspect ratio,and blood flow,and there was statistical significance.Malignant nodules were usually manifested as solid components?50%,low(very low)echo,unclear borders,irregular shapes,aspect ratio ?1,microcalcification,and rich blood flow signals inside the nodules.Logistic regression analysis showed that malignant nodules with solid components?50%,low(or very low)echo,unclear borders,aspect ratio ?1,microcalcification,and abundant blood flow signals inside the nodule were more severe.Type 4a nodules with microcalcification and aspect ratio ?1 are more prone to malignant changes.Conclusion:TI-RADS classification has high accuracy,sensitivity and specificity for the diagnosis of thyroid nodules.It improves the accuracy of diagnosis,and hashigh clinical value.The higher the TI-RADS grade,the higher the malignancy rate.Solid components ?50%,low(or very low)echo,unclear borders,aspect ratio ?1,microcalcification,and abundant blignals within the nodule are important for the evaluation of malignant risk of thyroid nodules.For types 1-3and type 4a nodules with a low risk of malignancy,we recommend temporarily conservative observations.And type 4a with high-risk signs and above should be treated as soon as possible.