| Objective:To explore the clinical application value of ultrasonography in the detection of benign and malignant thyroid nodules by clinical information laboratory and the clinical application value of fine needle puncture under the guidance of ultrasonography combined with the quantization scoring system of thyroid nodules,especially in the differentiation of benign and malignant thyroid nodules.Methods:Retrospective analysis of 100 cases of thyroid nodules admitted by the department of endocrinology of our hospital from October 2015 to June 2017 with fine needle puncture guided by ultrasound and confirmed by surgical pathology.Age,gender,location of nodules,diameter of nodules,serum TSH concentration,thyroid autoantibodies TPOAb,TgAb,autoantigen Tg,calcitonin,carcinoembryonic antigen,ultrasound signs,doppler ultrasound,ultrasound quantization system and fine needle puncture cytology were recorded for the differences between the benign and malignant thyroid nodules.Multivariate regression analysis was performed on indicators with statistical differences between the benign and malignant nodules to obtain independent risk factors with malignant thyroid nodules.Among them,there were 9 indicators in the blood flow pattern of cervical lymph nodes in the diameter boundary of the corona of the echo-intensity component calcification foci with nodules,which were included in the indicators of conventional gray ultrasonography and doppler ultrasonography;ultrasound guided fine needle biopsy cytology results using the national cancer institute proposed thyroid cytology classification criteria-classifying,bethesda system(BethesdaSystem),using the postoperative pathological results as the gold standard,ultrasound guided fine needle aspiration biopsy and combining both of the subjects operating characteristic(ROC)curve,compare the diagnostic value of three.Results:(1)A total of 100 patients with thyroid nodules were included,aged from 20 to 73(45.29±11.70),including 2 malignant nodules and 1 benign nodules in the age group under 20 years old.There were 10 cases of benign nodules and 22 cases of malignant nodules in the group of20 to 40 years old.There were 21 cases of benign nodules and 34 cases of malignant nodules in the group of 40-60 years old.There were 5 cases of benign nodules and 6 cases of malignant nodules in the group over 60 years old.But the age difference between benign and malignant thyroid nodules group is not significant(?2=2.632,P=0.452)(2)among the patients with thyroid nodules,15 were male and 85 were female,with a ratio of 1:5.67.Among the male patients,there were 11 cases of malignant nodules and 4cases of benign nodules.Among the female patients,53 cases were malignant nodules and 32cases were benign nodules.The number of women suffering from thyroid nodule is higher than male,but had no statistically significant gender and benign and malignant thyroid nodule(?2=0.667,P=0.414)(3)There were 37 cases of thyroid nodules in the left lobe,including 14 cases of benign nodules and 23 cases of malignant nodules.There were 63 cases in the right lobe,including 22 cases with benign nodules and 41 cases with malignant nodules.The comparison of thyroid nodules with benign and malignant nodules was not statistically significant(4)Serum TSH,calcitonin,cancerous embryo antigen,thyroid autoantibodies TPOAb,TgAb and Tg were compared between the benign and malignant thyroid nodules,and only the differences between the benign and malignant thyroid nodules were statistically significant(5)In benign and malignant thyroid nodules in the two groups,the ultrasonic signs and doppler ultrasound,the diameter difference in benign and malignant calcification low echo border differences between the two groups have statistical significance(?~2=29.213,P=0.000;?~2=14.458,P=0.000;?~2=5.953,P=0.015;?~2=10.635,P=0.001);However,there was no statistical difference between benign and malignant lymph node nodules in the two groups(6)Multivariate Logistic regression analysis showed that calcified TgAb ultrasound quantitatively graded fine needle puncture classification,and these four indicators were all independent risk factors for thyroid cancer.Thyroid ultrasonography suggested that nodules with calcified foci were 15.74 times more likely to develop thyroid cancer than nodules without calcified foci.TgAb positive patients were 7.12 times more likely to develop thyroid cancer than negative patients.(7)Areas under ROC curves of the ultrasonic quantitative scoring system,the ultrasonic guided fine needle puncture and the combination of both were 0.783,0.740 and 0.844,respectively.The optimal score cut point of ultrasonic quantitative scoring system is 2,that is,>2 points were diagnosed as malignant,and<2 points were diagnosed as benign.The sensitivity,specificity positive predictive value and negative predictive value of the quantitative scoring system of ultrasound were 84.37%,55.56%,77.14%,66.67%.The optimal score cut point of ultrasound-guided fine needle aspiration biopsy is point 3,the cytological classification?,?,? such as benign,?,?,?class for malignant,The sensitivity,specificity,positive predictive value and negative predictive value of ultrasound-guided fine needle aspiration biopsy were 79.69%,61.11%,78.46%,62.86%.The sensitivity,specificity,positive predictive value and negative predictive value of the combination of quantitive scoring system of ultrasound and FNAB were 85.94%,77.78%,87.30%,75.68%.(8)ultrasonography quantitative evaluation and grading fine needle aspiration biopsy combined diagnosis of benign and malignant thyroid nodule as the Logit regression equation(P=0.797)?ultrasonic score+0.600?fine needle aspiration biopsy classification-3.746.0.4 as the cut-off point diagnosis can achieve maximum efficiency.Conclusion:(1)The incidence of thyroid nodules is high between 40 and 60 years old,but the age difference is irrelevant to the benign and malignant thyroid nodules.(2)The incidence of thyroid nodules was higher in women than in men,but the sex was not associated with the benign or malignant thyroid nodules.(3)Benign or malignant thyroid nodules have nothing to do with the location of the nodules.(4)Serum TSH,calcitonin,carcinoembryonic antigen,TPOAb and Tg were not associated with benign or malignant thyroid nodules,and calcification foci,TgAb,ultrasonography quantification score and fine needle puncture classification were independent risk factors for thyroid cancer.Thyroid ultrasonography showed that nodules with calcification were 15.74 times more likely to develop thyroid cancer than nodules without calcification.TgAb positive patients had a 7.12 times higher risk of thyroid cancer than negative patients.The higher the ultrasound quantization score,the higher the potential risk of thyroid cancer,the higher the fine needle puncture classification,and the greater the potential risk of thyroid cancer(5)The diagnostic efficacy of quantitative scoring system of ultrasound combined with fine needle puncture for beign and malignant thyroid nodules is higher than that of a single diagnostic method. |
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