Conventional Ultrasonography And Contrast-enhanced Ultrasonography In Papillary Thyroid Carcinoma Complicated With Hashimoto’s Thyroiditis

Objective To investigate the clinical diagnostic value of conventional ultrasound(US)and contrast-enhanced ultrasound(CEUS)in differentiating benign and malignant thyroid nodules(TNs)in Hashimoto’s Thyroiditis(HT)and non-HT backgrounds.Methods This study retrospectively analyzed 139 TNs in 114 patients with non-HT background,including 90 malignant TNs and 49 benign TNs confirmed by surgery and pathology;80 TNs in 57 HT patients,and 53 malignant TNs and 27 benign TNs confirmed by surgery and pathology;malignant TNs were confirmed to be papillary thyroid carcinoma(PTC),benign TNs were confirmed to be nodular goiter.The location,size,edge,shape,aspect ratio,echo,calcification,halo,blood color and other parameters of the nodule were obtained by conventional US;the peak intensity,enhancement mode,perfusion mode,time to peak,and under the curve of the nodule were obtained by CEUS.The nodules were comprehensively evaluated by parameters such as area and average transit time.Univariate analysis was used to compare whether the difference of parameters in distinguishing benign and malignant nodules in HT and non-HT backgrounds and the difference in PTC in HT and non-HT backgrounds were statistically significant.Multivariate logistic regression analysis was used to obtain independent risk factors for malignant TNs in HT and non-HT backgrounds.Results The gender,aspect ratio,edge,echo,calcification,and enhancement pattern of benign and malignant nodules in non-HT background were statistically significant(P<0.05),other characteristics were not statistically significant.Multivariate Logistic linear regression analysis showed that(extreme)hypoechoic,microcalcification and aspect ratio >1 were independent risk factors for PTC in the non-HT background(OR=23.22,4.48,3.25,P=0.000,0.009,0.037).The echo,calcification,enhancement pattern,perfusion pattern,peak intensity ratio,and average perfusion time ratio of benign and malignant thyroid nodules in the HT background were statistically significant(P<0.05),other characteristics were not statistically significant.Logistic linear regression analysis showed that microcalcification and low enhancement were independent risk factors for PTC in the HT background(OR=8.47,17.81,P=0.003,0.001).Irregular halo,microcalcification,aspect ratio,perfusion pattern,mean transit time ratio,and cervical lymph node metastasis of PTC in both groups under HT and non-HT backgrounds were statistically significant(P<0.05),other characteristics were not found statistically significant,multivariate logistic linear regression analysis showed that microcalcification and no irregular halo were independent risk factors for HT combined with PTC(OR=0.47,0.13,P=0.043,0.001).Conclusion Mastering the ultrasound characteristics of benign and malignant nodules in HT and non-HT backgrounds can help improve the detection rate of malignant nodules,help avoid unnecessary fine needle aspiration and surgical treatment of benign nodules,help design an individualized approach to precision surgical treatment.