Features Analysis On Ultrasound Differential Diagnosis Of Papillary Thyroid Carcinoma And Benign Thyroid Nodules

Objective:This paper compared ultrasonic features of benign thyroid nodules and papillary thyroid carcinoma(PTC)and analyzed their causes of development.And an overall investigation was made on clinical data and laboratory inspection of the two,to explore diagnostic value and limitations of their ultrasound differential signs,so as to offer objective evidences of ultrasound imaging for the diagnosis of PTC.Methods:60 patients(83 nodules)with thyroid nodules were enrolled for retrospective analysis,and their pathological confirmations were achieved either by surgery or ultrasound-guided fine needle aspiration cytology(US-FNAC).Two groups were divided based on the pathological diagnosis:30 patients in the benign nodule group and 30 patients in the PTC group.Records on clinical data,laboratory examination and ultrasonography results were kept for contrastive analysis.The components of ultrasonography covered aspect ratio(A/T)of nodules,shapes,internal structures and echogenicities,calcifications and maximum diameter of incision,margins,halo signs and blood flow distribution patterns as well.The sensitivity,specificity,likelihood ratio and diagnostic accuracy of the differential signs were calculated.Results:1.Significant differences(P<0.05)were exhibited in A/T≥1,irregular shape,microcalcification,hypoechogenicity,solid,lack of halo sign,and fuzzy margin after comparison of papillary carcinoma and benign nodules.Among them,A/T≥1 revealed the highest specificity(95.6%)with the highest positive likelihood ratio of 9.57;The highest sensitivity of hypoechogenicity displayed 92.1%with the lowest negative likelihood ratio of 0.12;The highest diagnostic accuracy of shape irregularity reached 88.0%.2.Two-dimensional ultrasound findings showed that the average maximum diameter of papillary carcinoma section was lower than that of the benign nodules.Difference was found between the two groups after comparison(P<0.01).3.Color doppler findings displayed difference in comparison of blood flow distribution patterns between papillary carcinoma and benign nodules(P<0.01).Blood flow distribution patterns in papillary tumor cases were mostly type Ⅱ and Ⅰ.4.Difference in TI-RADS classification was found between the two groups after comparison(P<0.01).Most benign nodules were classified as 4a or below.Most papillary carcinomas were classified as 4c or above.While the two overlapped at the level of 4b.5.Laboratory examination demonstrated a remarkable difference in TSH was found between the two groups after comparison(P<0.05).The average level of TSH for papillary carcinoma cases was higher than that of benign nodules.6.Clinical statistics revealed that no difference was found in gender and age for both groups(P>0.05).The incidence age of both benign nodules and papillary carcinoma was over 45 years old.Female cases were more than male.Conclusion:1.Compared with the other two signs including solid and hypoechogenicity,three ultrasonic differential signs of nodules A/T>1,irregular shape,and microcalcification presented higher specificity and positive likelihood ratio,which were contributive to the diagnosis of PTC.2.Diagnostic accuracy of both nodule margin and halo sign was inferior to other ultrasonic signs.3.Papillary thyroid microcarcinoma(PTMC)developed a high incidence.4.Majority of PTC lack internal blood supply.5.Level 4b nodules by ultrasound TI-RADS classification tended to overlap with benign and malignant nodules.6.The average level of TSH for papillary carcinoma cases was higher than that of benign nodules.It is suspicious that TSH elevation may be associated with papillary carcinoma.7.Clinical research findings revealed that thyroid nodule lesions presented more common in female with the age of onset over 45 years old.