Application Of Real-time Shear Wave Elastography Combined With Tg-Ab Detection In The Diagnosis Of Thyroid Cancer

ObjectiveTo analyze the efficacy of real-time shear wave elastography(RT SWE)combined with thyroglobulin antibody(Tg-Ab)detection in the diagnosis of thyroid cancer,and to explore the feasibility of combining imaging examination with biochemical examination index in the diagnosis of thyroid cancer,so as to provide scientific basis for clinical diagnosis of thyroid cancer.Methods98 patients were confirmed by pathological biopsy thyroid cancer in our hospital from Jan.2017 to Dec.2019 were selected.SWE was performed on all subjects,and pathological examination was taken as the gold standard to analyze the efficacy of swe in the diagnosis of thyroid cancer;meanwhile,the serum Tg-Ab levels of all subjects were examined,and the differences of serum Tg-Ab levels between malignant and benign thyroid nodules were compared;the efficacy of swe combined with serum Tg-Ab levels in the diagnosis of thyroid cancer was analyzed by receiver operating characteristic(ROC)curve To analyze the relationship between serum Tg-Ab level and clinicopathological characteristics of patients with thyroid cancer.Results1.General information of patients: 98 cases were confirmed by pathological biopsy among 428 patients suspected of thyroid diseases.Pathological diagnosis:330 cases of benign nodules,246 cases of nodular goiter,71 cases of thyroid adenoma,13 cases of focal Hashimoto’s thyroiditis;98 cases of malignant nodules,78 cases of papillary thyroid carcinoma,16 cases of fol icular adenocarcinoma,4cases of undifferentiated carcinoma.There were 32 males and 66 females with an average age of(48.89 ± 5.14)years(Range,28-78 years).The diameter of the lesions ranged from 0.8 cm to 3.9 cm,with an average of(2.34 ± 1.05)cm.Clinical stage: 49 cases(50.00%)were stage Ⅰ-Ⅱ;49 cases(50.00%)were stage Ⅲ-Ⅳ.There were 535 cases with lymph node metastasis(54.08%),45 cases without lymph node metastasis(45.92%).23 cases(23.47%)had single nodule and 75 cases(76.53%)had multiple nodule.2.The efficacy of SWE in the diagnosis of thyroid cancer: The pathological diagnosis was taken as the gold standard,and the results of swe examination and pathological examination was consistency between the two examinations(Kappa =0.637,P = 0.000),and the Kappa was between 0.4～0.7,and the consistency was general.The sensitivity of SWE was 69.44%,the specificity of SWE was 92.81%,the accuracy of SWE was 86.92%.3.The elastic modulus of SWE in benign thyroid nodules was(24.52±5.19)kPa,SWE elastic modulus(90.25 ± 12.87)kPa.The difference of the elastic modulus was statistically significant(t = 74.691,P < 0.001).4.Comparison of serum Tg-Ab level between benign and malignant thyroid patients: The difference of the level of Tg-Ab for the patients with thyroid cancer[(125.16 ± 32.24)IU / ml] and benign thyroid disease(31.58±2.46)IU / ml] was statistical y significant(t=51.802,P<0.001).5.The efficacy of the Tg-Ab level in the diagnosis of thyroid cancer: The pathological diagnosis was taken as the gold standard,and the results of SWE examination and pathological examination was consistency between the two examinations(Kappa = 0.692,P = 0.000),and the Kappa was between 0.4～0.7,and the consistency was general.The sensitivity of Tg-Ab was 83.33%,the specificity of Tg-Ab was 89.33%,the accuracy of Tg-Ab was 88.32%%.6.The efficacy of SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer: the pathological diagnosis was taken as the gold standard,and the results of SWE examination and pathological examination was consistency between the two examinations(Kappa=0.928,P < 0.001),Kappa > 0.7,the results were consistent.The sensitivity,specificity and accuracy of SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer were 92.23%,99.08% and 97.43%.7.Comparison of SWE,serum Tg-Ab and SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer: The difference of the sensitivity,specificity and accuracy of SWE and SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer was statistical y significant(P < 0.05).8.The ROC curve of SWE and SWE combined with serum Tg-Ab level in the diagnosis of thyroid cancer: The each cut-off point was regarded as positive diagnosis,the remaining diagnosis was regarded as negative diagnosis,and the sensitivity and specificity of each cut-off point were calculated according to the gold standard of pathological diagnosis.The difference of AUC the ROC curve of the three groups was statistical y significant(P < 0.001).Conclusion1.The positive rate of swe combined with serum Tg-Ab in the diagnosis of thyroid cancer is higher than that of swe examination and serum Tg-Ab examination alone;the results of SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer are consistent with pathological diagnosis,while the results of SWE examination and serum Tg-Ab examination alone are consistent with pathological diagnosis,which can improve the judgment of benign and malignant thyroid nodules and reduce the misdiagnosis rate.2.The level of serum Tg-Ab in patients with thyroid cancer is higher than that in patients with benign thyroid diseases,suggesting that the level of serum Tg-Ab can be used as an index to differentiate benign and malignant thyroid diseases.3.The sensitivity,specificity and accuracy of SWE combined with serum Tg-Ab in the diagnosis of thyroid cancer were higher than those of SWE and serum Tg-Ab alone.The ROC line analysis showed that SWE combined with serum Tg-Ab had higher diagnostic efficiency in the diagnosis of thyroid cancer.SWE combined with serum Tg-Ab could not only provide information of tissue structure and hardness,but also increase the diagnosis of molecular pathology It plays an important role in the diagnosis of benign and malignant thyroid nodules.