The Value Of Computer-aided Diagnosis System Combined With Ultrasound Elastography In Distinguishing Benign And Malignant Thyroid Nodules

Objective: To analyze the diagnostic value of thyroid ultrasound image analysis system(CAD system)combined with ultrasonic shear wave elastography(SWE)in benign and malignant thyroid nodules.To explore the influencing factors of CAD system between benign and malignant thyroid nodules.Methods: 146 thyroid nodules were selected for fine-neddle aspiration(FNA)or surgical resection.All patients underwent routine ultrasonography,CAD system diagnosis and SWE inspection.According to the KWAK guidelines,the pathological results were used as the gold standard.The diagnostic efficacy of the physician’s interpretation and the CAD system were compared.The influence factors of the quantified ultrasound features in the CAD system on the diagnosis of benign and malignant thyroid nodules were analyzed.Receiver operating characteristic curve(ROC curve)was drawn to obtain the cutoff value of SWE for benign and malignant thyroid nodules.The area under curve of the maximum Young’s modulus(Emax)and the average(Emean)were compared to calculate the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of SWE in the diagnosis of benign and malignant thyroid nodules.Compare the diagnostic efficacy of Emax and Emean.When calculating the best diagnosis critical point to distinguish benign from malignant,the sensitivity,specificity and accuracy of CAD system combined with SWE for the diagnosis of thyroid nodules were compared with those of manual interpretation、 CAD system and SWE technology.Results: When TI-RADS ≥ 4b was used as the best diagnostic cut-off point,the sensitivity of CAD system and physicians to distinguish benign and malignant thyroid nodules was 90.91% and 75.32%,respectively.The difference was statistically significant(P = 0.000),The accuracy rates were 85.62% and 82.19%,and the difference was statistically significant(P = 0.000).The consistency between the two is good(Kappa value = 0.690).Among the quantitative features of the CAD system,low echo,microcalcification and aspect ratio> 1 can effectively distinguish benign and malignant thyroid nodules and the difference was statistically significant(P <0.05).Using pathological results as the gold standard,the area under the ROC curve of Emax and Emean values were 0.932 and 0.812,and the best cut-off values were 0.77 kpa and 20.93 kpa.Compared with the Emean value,the Emax value had higher sensitivity,specificity,positive predictive value and negative predictive value.The sensitivity of CAD system,physician interpretation,SWE technology and CAD system combined with SWE were 90.91%,75.32%,90.91% and 98.70%,and the specificity was 79.71%,89.6%,95.65% and 76.81%,and the accuracy rates was 85.62%,82.19%,93.15%,88.36%,respectively.Conclusion: CAD system combined with SWE technology can improve the diagnostic efficiency of qualitative diagnosis of thyroid nodules,which has good clinical significance and application value.Low echo,microcalcification,and aspect ratio> 1 are the main influencing factors for the CAD system to distinguish benign and malignant thyroid nodules.