| Objective To analyze the relationship between the general characteristics of patients(age and gender),color Doppler ultrasound characteristics of thyroid and cervical lymph nodes,serological examination(TSH,TGAb,TPOAb)and benign and malignant single thyroid nodule,so as to provide more accurate reference for clinical diagnosis and treatment and whole process management of patients with single thyroid nodule.Methods To collect the clinical and postoperative paraffin pathological data of patients with thyroid nodules admitted to General Hospital of Ningxia Medical University hospital from January 1,2018 to January 1,2019,who underwent surgery to determine the nature of the nodules.All patients need to improve the preoperative thyroid and cervical lymph nodes color Doppler ultrasound and serum TSH,TGAb,TPOAb level,and finally through postoperative paraffin pathological to determine the benign and malignant of nodules.All patients were divided into the malignant thyroid nodule group(malignant group)and the benign thyroid nodule group(benign group)according to the paraffin section report.Statistical analysis by spss22.0.Single factor analysis was performed on age,gender,and the levels of TSH,TGAb and TPOAb,and the characteristics of color doppler ultrasound examination of thyroid and cervical lymph nodes,including nodule size,morphology,edge,location,calcification,aspect ratio and abnormal structure of cervical lymph nodes,Comparing the differences of the above indicators between the two groups.And then use the Multivariate Logistic regression to analyze the correlation of indicators with significant difference in univariate analysis.Results 1.The relationship between the patient’s general condition and the benign ormalignant single thyroid nodule:(1)gender: a total of 343 patients were included in this study,including 46 males and 149 females in the malignant group,36 males and 112 females in the benign group.There was no statistically significant difference between the two groups(P >0.05).(2)age: The mean age of the benign group was 47.20±10.63 years,including 89 patients≥45 years and 59 patients <45 years.The mean age of the malignant group was 43.59±11.79 years,including 96 patients ≥45 years old and 99 patients <45 years old.Compared with the two groups,the mean age of the malignant group was smaller,more were less than 45 years old in the malignant group,and the difference was statistically significant(P≤0.05).2.The relationship between the characteristics of color Doppler ultrasonography of thyroid and cervical lymph nodes and the benign or malignant single thyroid nodule:(1)size:the average size of nodules in the benign group was 3.46±1.44 cm,with 142 cases ≥1cm and 6cases <1cm.And average size of 1.5±1.15 cm in the malignant group,with 128 patients ≥1cm and 67 patients <1cm.The data showed that the nodules in the malignant group were smaller,and more were <1cm,and the difference was statistically significant(P≤0.05).(2)Location:Among 209 patients with definite nodule location,64 were benign and 145 were malignant.There were 43 cases of malignant nodule and 11 of benign nodule at the upper pole;55 cases of malignant nodule and 18 of benign nodule in the middle;47 malignant nodules and 35 benign ones at the lower pole.Compare the upper,middle and lower nodules,the results showed that there was no significant difference between the benign and malignant of the nodule in the middle and the upper(P>0.05),but there was significant difference between the nodule from the lower pole and the nodule from the upper and the middle(P≤0.05),and the benign proportion of the nodule in the lower pole was larger,suggesting that the nodule from the lower pole was more likely to be benign.(P≤0.05).(3)boundaries: in the benign group,the boundaries were clear in 121 cases and unclear in 27cases;in the malignant group,the boundaries were clear in 74 cases and unclear in 121 cases.The data showed that there was a statistically significant difference between the two groups(P≤0.05).(4)morphology: in the benign group,129 cases had regular morphology and 19 cases had irregular,while in the malignant group,48 cases had regular morphology and 147 irregular.According to the data,the morphology was correlated with the benign and malignant nodules,and the difference between the two groups was statistically significant(P≤0.05).(5)Aspect ratio: in the benign group,the aspect ratio of all nodules is less than 1,in the malignant group,there are 153 cases whose aspect ratio is less than 1,42 cases is more than 1.Compared with the two groups,there are few nodules whose aspect ratio is more than1 in the benign group and more nodules whose aspect ratio is more than 1 in the malignant group,the difference is statistically significant(P≤0.05).(6)Calcification: in benign group,there were 42 cases with calcification,106 cases without.In malignant group,there were 149 cases with calcification and 46 cases without.Compared with the two groups,there were more nodules without calcification in benign group and more nodules with calcification in malignant group,the difference was statistically significant(P≤0.05).(7)Cervical lymph nodes: In the benign nodule group,147 cases had no abnormal structure of cervical lymph nodes,1 case had abnormal structure;in the malignant nodule group,154 cases had no abnormal structure of cervical lymph nodes,41 cases had abnormal structure.According to the data,the cervical lymph node structure of the benign group was mostly normal,while that of the malignant group was mostly complicated with cervical lymph node structure,and the difference between the two groups was statistically significant(P≤0.05).3.The relationship between serum TSH,TGAb and TPOAb levels and the benign or malignant single thyroid nodule:(1)TSH: the mean value of TSH in benign group was 2.31±1.98u/ml,in malignant nodule group was 2.42±1.37u/ml.In benign group,10 cases were less than 0.35 IU / ml,7 cases were more than 5.5 IU / ml,131 cases were between 0.35 and 5.5IU / ml;in malignant group,179 cases were between 0.35 and 5.5 IU / ml,9 cases were less than 0.35 IU / ml,7 cases were more than 5.5 IU / ml.There was no significant difference in TSH between the two groups(P > 0.05).(2)TGAb: in the benign group,there were 129 casesof TGAb negative,19 cases positive.In the malignant group,145 cases of TGAb negative,50 cases positive.From the data,the positive rate of TGAb in malignant group was higher than that in benign,and the difference between the two groups was statistically significant(P≤0.05).(3)TPOAb: in benign group,TPOAb was negative in 131 cases,positive in 17.In malignant group,TPOAb was negative in 88 cases,positive in 107.By comparison,the difference of TPOAb level between the two groups was statistically significant(P≤0.05),indicating that TPOAb level was related to benign and malignant nodules.4.Multivariate logistic regression analysis showed that the age of patients,the size,boundary,morphology,calcification,the structure of cervical lymph nodes and the level of serum TPOAb were independent risk factors for the evaluation of nodal malignancy(P≤0.05).Conclusions 1.Gender was not associated with benign or malignant single thyroid nodule,and age < 45 years was an independent risk factor for malignant single thyroid nodule.2.Color Doppler ultrasound of thyroid and cervical lymph nodes showed that the nodules with size less than 1cm,unclear boundary,irregular shape,aspect ratio≥1,calcification and abnormal structure of cervical lymph nodes were more likely to be malignant.3.Nodules from the lower pole of the thyroid gland are more likely to be benign.4.There was no significant relationship between serum TSH level and benign or malignant single thyroid nodule.The patients with positive serum TGAb and(or)TPOAb had a high probability of malignant nodule. |
