Study on clinical value of ultrasound elastography combined with ACR-TIRADS in differential diagnosis of benign and malignant thyroid nodules

doi:10.16150/j.1671-2870.2019.03.012

Abstract

Abstract:

Objective: To analysis retrospectively the value of The Thyroid Imaging Report and Data System recommended by American College of Radiology (ACR-TIRADS) 2017 and ultrasound elastographyalone or in combination for the differential diagnosis of benign and malignant thyroid nodules. Methods: From January 2012 to October 2017, 503 patients with 653 thyroid nodules underwent preoperative thyroid ultrasonography and thyroidectomy at the Integrated Chinese Traditional Medicine and Western Medicine Hospital were enrolled. General clinical information, thyroid ultrasound report, ultrasound elastography and results of postoperative pathology were collected. All the nodules were graded by ACR-TIRADS, elastography grading and scoring system. The four differential diagnostic categories were as follows:category 1, either elastography or ACR-TIRADS considered as malignant nodules; category 2, both elastography and ACR-TIRADS considered as malignant nodules; category 3, elastography score and grade of ACR-TIRADS added; category 4, elastography score and ACR-TIRADS score added. The postoperative pathological results were regarded as a gold standard to construct the receiver operating-characteristic curve (ROC), calculate the area under the curve (AUC), and the best cutoff value was defined according to the Yoden index. Results: The AUC of ACR-TIRADS was as high as that of ultrasound elastography (0.853 vs. 0.848, P=0.745). Category 1 had a differential diagnosis value with higher sensitivity (96.94%) and the negative predictive value (84.85%). The category 2 had a specificity of 88.96% and a positive predictive value of (95.53%). The sensitivity of category 3 was higher than that of category 4 (88.78% vs. 85.92%, P<0.001). There was no statistical difference between AUC of category 3 of category 4.(0.913 vs. 0.901, P=0.088). Conclusions: ACR-TIRADS is superior to ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. Both category 3 and category 4 are superior to ACR-TIRADS or ultrasound elastography alone. The category 4 has a higher discriminatory value in the differential diagnosis of benign and malignant thyroid nodules.

Key words: Thyroid nodules, Ultrasound elastography, Thyroid Imaging Reporting and Data System

CLC Number:

R736.1

JI Qin, ZHOU Yifan, CHEN Mo, LI Jie, DING Wenbo, QIAN Tao, CHU Xiaoqiu, WANG Jianhua, XU Shuhang, LIU Chao. Study on clinical value of ultrasound elastography combined with ACR-TIRADS in differential diagnosis of benign and malignant thyroid nodules[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 307-312.

Figures/Tables 4

References 17

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诊断方法	分级	最终病理		总计（n=653）	恶性率（%）	P值
诊断方法	分级	良性（n=163）	恶性（n=490）	总计（n=653）	恶性率（%）	P值
ACR-TIRADS						<0.001
	2	36	3	39	7.69
	3	48	12	60	20.00
	4	55	110	165	66.67
	5	24	365	389	93.83
弹性成像评分（分）						<0.001
	1	29	6	35	17.14
	2	110	93	203	45.81
	3	12	132	144	91.67
	4	12	257	269	95.54
	5	0	2	2	100.00
方法1	1	84	15	99	15.15	<0.001
	2	79	475	554	85.74
方法2	1	145	105	250	42.00	<0.001
	2	18	385	403	95.53
方法3						<0.001
	3	7	0	7	0.00
	4	33	2	35	5.71
	5	55	10	65	15.38
	6	42	43	85	50.59
	7	9	80	89	89.89
	8	7	139	146	95.21
	9	10	214	224	95.54
	10	0	2	2	100.00
方法4						<0.001
	1	7	0	7	0
	2	76	10	86	11.63
	3	41	22	63	34.92
	4	35	233	268	86.94
	5	4	225	229	98.25

方法	最佳临界值	灵敏度(%)	特异度(%)	PPV(%)	NPV(%)	准确率(%)	AUC
ACR-TIRADS	5	74.49	85.28	93.83	52.65	77.18	0.853^a)
弹性成像	3	79.80	85.28	94.22	58.40	81.16	0.848^a)
方法1	2	96.94	51.53	85.74	84.85	85.60	0.739^a)
方法2	2	78.57	88.96	95.53	58.00	81.16	0.838^a)
方法3	7	88.78	84.05	94.36	71.35	87.60	0.901
方法4	3	85.92	84.05	94.18	66.50	85.45	0.913