Original articles

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

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  • a. Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
    b. Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
    c. Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China

Received date: 2018-12-25

  Online published: 2019-06-25

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.

Cite this article

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 . DOI: 10.16150/j.1671-2870.2019.03.012

References

[1] 孙可欣, 郑荣寿, 张思维, 等. 2015年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2019, 28(1):1-11.
[2] Xue J, Cao XL, Shi L, et al. The diagnostic value of combination of TI-RADS and ultrasound elastography in the differentiation of benign and malignant thyroid nodu-les[J]. Clin Imaging, 2016 Sep-Oct, 40(5):913-916.
[3] Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee[J]. J Am Coll Radiol, 2017, 14(5):587-595.
[4] Gao L, Xi X, Jiang Y, et al. Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules[J]. Endocrine, 2019, 64(1):90-96.
[5] Xu T, Wu Y, Wu RX, et al. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination[J/OL]. Endocrine. 2018-11-24[2018-12-25]. https://www.ncbi.nlm.nih.gov/pubmed/30474824.
[6] 胡维茜, 黄枢. 超声弹性成像对甲状腺结节良恶性鉴别诊断的应用价值[J]. 临床超声医学杂志, 2016, 18(7):480-482.
[7] 李伟兰, 潘春梅, 高博, 等. 常规超声联合超声弹性成像在甲状腺结节鉴别诊断中的应用[J]. 中华危重症医学杂志(电子版), 2017, 10(3):188-191.
[8] Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis[J]. Radiology, 2006, 239(2):341-350.
[9] Wu XL, Du JR, Wang H, et al. Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines[J/OL]. Endocrine. 2019-03-04[2018-12-25]. https://www.ncbi.nlm.nih.gov/pubmed/30830584.
[10] 张于芝, 徐婷, 顾经宇, 等. 2017美国放射学会甲状腺影像报告和数据系统(ACR-TIRADS)对甲状腺结节鉴别诊断的效能评估[J]. 中华超声影像学杂志, 2018, 27(6):505-509.
[11] 康艺萍, 郭相华, 练锋. 常规超声与超声弹性成像检测甲状腺良恶性肿瘤的临床价值[J]. 中国肿瘤临床与康复, 2019, 26(2): 129-132.
[12] 何翠云. 超声及超声弹性成像在诊断甲状腺良恶性结节中的价值分析[J]. 影像研究与医学应用, 2019, 3(5):91-92.
[13] 赵俊丽, 赵俊峰, 刘瑞霞, 等. 超声TI-RADS分级法和弹性成像技术对甲状腺结节定性诊断的效能比较[J]. 临床超声医学杂志, 2018, 20(4):267-270.
[14] Hang J, Li F, Qiao XH, et al. Combination of Maximum Shear Wave Elasticity Modulus and TIRADS Improves the Diagnostic Specificity in Characterizing Thyroid Nodules: A Retrospective Study[J]. Int J Endocrinol, 2018, 2018:4923050.
[15] Liu Z, Jing H, Han X, et al. Shear wave elastography combined with the thyroid imaging reporting and data system for malignancy risk stratification in thyroid nodu-les[J]. Oncotarget, 2017, 8(26):43406-43416.
[16] Schenke S, Zimny M. Combination of Sonoelastography and TIRADS for the Diagnostic Assessment of Thyroid Nodules[J]. Ultrasound Med Biol, 2018, 44(3):575-583.
[17] 李静, 侯苏芸, 付超, 等. 美国放射学会甲状腺影像报告和数据系统解读与探讨[J]. 中华超声影像学杂志, 2018, 27(2):180-184.
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