Diagnostic value on the qualitative diagnosis of the different ways of TI-RADS 4 category thyroid nodules less than or equal to 1 cm

doi:10.3877/cma.j.issn.2095-655X.2021.04.004

Abstract

Abstract:

Objective

To compare the diagnostic value of ultrasound-guided fine needle aspiration cytology (UG-FNAC) combined with BRAF^V600E gene mutation and contrast-enhanced ultrasound (CEUS) for thyroid imaging reporting and data system (TI-RADS) type 4 thyroid nodules less than or equal to 1 cm.

Methods

From January 2017 to December 2019, 98 patients with 105 TI-RADS type 4 thyroid nodules less than or equal to 1 cm confirmed by surgery and pathological examination in Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were analyzed, UG-FNAC, BRAF^V600E and CEUS were performed before surgery. The results were compared with surgical pathology which regarded as the " gold standard" .

Results

The diagnostic rates of malignancy (number of malignancy) were 63.81%(67/105), 43.81%(46/105), 55.24%(58/105), 66.67%(70/105), and 53.33%(56/105) for histopathology of surgery, UG-FNAC, UG-FNAC combined with BRAF^V600E, CEUS, UG-FNAC and BRAF^V600E combined with CEUS, respectively, and all malignant nodules were papillary thyroid microcarcinoma (PTMC). The sensitivities of UG-FNAC, UG-FNAC combined with BRAF^V600E, CEUS, UG-FNAC and BRAF^V600E combined with CEUS were 67.16%, 83.58%, 86.57%, 83.58%, and the specificities were 97.37%, 94.74%, 68.42%, 100.00%, respectively. The Kappa values of UG-FNAC, UG-FNAC combined with BRAF^V600E, CEUS, UG-FNAC and BRAF^V600E combined with CEUS were 0.58, 0.75, 0.56, 0.79, and the areas under the curve of receiver operating characteristic (ROC) were 0.823, 0.892, 0.775, 0.918 (all P<0.05), respectively.

Conclusion

UG-FNAC and BRAF^V600E combined with CEUS has higher accuracy and diagnostic value in the diagnosis of TI-RADS type 4 thyroid nodules less than or equal to 1 cm.

Key words: Thyroid nodule, Thyroid imaging reporting and data system, Ultrasonography, Biopsy, fine-needle, BRAF^V600E gene

Han Wu, Yunji Wang, Shang Cai, Xuan Jiang, Yuxiang Zhu, Caifeng Yan, Shangyong Feng. Diagnostic value on the qualitative diagnosis of the different ways of TI-RADS 4 category thyroid nodules less than or equal to 1 cm[J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(04): 232-236.

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References 12

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组别	一般资料				甲状腺功能			甲状腺抗体
组别	例数	年龄[岁，M(P₂₅，P₇₅)]	男/女(例)	直径[mm，M(P₂₅，P₇₅)]	FT₃(pmol/L，±s)	FT₄(pmol/L，±s)	TSH(mU/L，±s)	TPOAb[mU/I，M(P₂₅，P₇₅)]	TGAb[mU/I，M(P₂₅，P₇₅)]
良性组	35	43(37，51)	10/25	6.80(3.70，10.00)	4.32±1.07	17.72±3.21	2.54±1.18	10.80(4.20，32.80)	38.10(16.80，88.60)
恶性组	62	38(35，53)	22/40	7.20(3.60，10.00)	4.11±1.26	16.78±3.56	2.99±1.78	12.10(4.40，30.20)	40.10(13.20，84.20)
统计量		Z＝1.32	χ²＝0.48	Z＝0.94	t＝0.83	t＝1.29	t＝1.34	Z＝1.12	Z＝1.54
P值		P＝0.188	P＝0.487	P＝0.352	P＝0.408	P＝0.199	P＝0.184	P＝0.258	P＝0.117

组别	一般资料				甲状腺功能			甲状腺抗体
组别	例数	年龄[岁，M(P₂₅，P₇₅)]	男/女(例)	直径[mm，M(P₂₅，P₇₅)]	FT₃(pmol/L，±s)	FT₄(pmol/L，±s)	TSH(mU/L，±s)	TPOAb[mU/I，M(P₂₅，P₇₅)]	TGAb[mU/I，M(P₂₅，P₇₅)]
良性组	35	43(37，51)	10/25	6.80(3.70，10.00)	4.32±1.07	17.72±3.21	2.54±1.18	10.80(4.20，32.80)	38.10(16.80，88.60)
恶性组	62	38(35，53)	22/40	7.20(3.60，10.00)	4.11±1.26	16.78±3.56	2.99±1.78	12.10(4.40，30.20)	40.10(13.20，84.20)
统计量		Z＝1.32	χ²＝0.48	Z＝0.94	t＝0.83	t＝1.29	t＝1.34	Z＝1.12	Z＝1.54
P值		P＝0.188	P＝0.487	P＝0.352	P＝0.408	P＝0.199	P＝0.184	P＝0.258	P＝0.117

组别	结节数目	TI-RADS亚类			UG-FNAC						BRAF^V600E		CEUS
组别	结节数目	4a	4b	4c	Ⅰ类	Ⅱ类	Ⅲ类	Ⅳ类	Ⅴ类	Ⅵ类	野生型	突变型	均匀增强	环状增强	无增强	不均匀增强
良性组	38	20	13	5	8	18	8	3	1	0	37	1	10	15	1	12
恶性组	67	19	23	25	9	2	4	7	18	27	25	42	8	1	0	58
统计量		Z＝8.67			Z＝37.20						χ²＝41.86		χ²＝43.93
P值		P<0.05			P<0.05						P<0.05		P<0.05

组别	结节数目	TI-RADS亚类			UG-FNAC						BRAF^V600E		CEUS
组别	结节数目	4a	4b	4c	Ⅰ类	Ⅱ类	Ⅲ类	Ⅳ类	Ⅴ类	Ⅵ类	野生型	突变型	均匀增强	环状增强	无增强	不均匀增强
良性组	38	20	13	5	8	18	8	3	1	0	37	1	10	15	1	12
恶性组	67	19	23	25	9	2	4	7	18	27	25	42	8	1	0	58
统计量		Z＝8.67			Z＝37.20						χ²＝41.86		χ²＝43.93
P值		P<0.05			P<0.05						P<0.05		P<0.05

方法	结果	术后组织病理(个)		阳性预测值(%)	阴性预测值(%)	敏感度(%)	特异度(%)	曲线下面积(95%CI)
方法	结果	良性	恶性	阳性预测值(%)	阴性预测值(%)	敏感度(%)	特异度(%)	曲线下面积(95%CI)
UG-FNAC	良性	37	22	97.83	62.71	67.16	97.37	0.823(0.736~0.890)
	恶性	1	45	97.83	62.71	67.16	97.37	0.823(0.736~0.890)
UG-FNAC联合BRAF^V600E	良性	36	11	96.55	76.60	83.58	94.74	0.892(0.816~0.944)
	恶性	2	56	96.55	76.60	83.58	94.74	0.892(0.816~0.944)
CEUS	良性	26	9	82.86	74.29	86.57	68.42	0.775(0.683~0.851)
	恶性	12	58	82.86	74.29	86.57	68.42	0.775(0.683~0.851)
UG-FNAC联合BRAF^V600E联合CEUS	良性	38	11	100.00	77.55	83.58	100.00	0.918(0.848~0.963)
UG-FNAC联合BRAF^V600E联合CEUS	恶性	0	56	100.00	77.55	83.58	100.00	0.918(0.848~0.963)

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