Pathological and Clinical Correlation European Union-Thyroid Imaging Reporting and Data System (EU-TIRADS) Classification of Thyroid Nodules in Two University Hospitals in Cotonou

Introduction: Since its creation in 2017 by the European community, the EU-TIRADS classification has enjoyed an excellent reputation in several countries around the world. Indeed, several studies conducted in these countries testify to the effectiveness of this tool for the management of nodular thyroid pathology. However, in Benin, the contribution of this classification has not yet been evaluated. It is therefore to overcome this inadequacy that we undertook this study. Objective: Participate in improving the diagnostic and therapeutic management of thyroid nodules at the CNHU HKM in Cotonou and at the CHUZ in Suru-Léré. Methods: This is a cross-sectional study with retrospective data collection spread over a period of 3 years 5 months, from January 2019 to May 2022 and carried out jointly in the Endocrinology Metabolism Nutrition and ORL-CCF departments of the CNHU HKM of Cotonou and in the ORL-CCF department of the CHUZ of Suru-Léré. The study population consisted of patients who consulted the University Clinic of Endocrinology Metabolism Nutrition, the University Clinic of ORL-CCF of the CNHU-HKM and the University Clinic of ORL-CCF of the CHUZ of Suru-Léré for thyroid nodule and who have had surgery. The study data was collected from patients hospitalization records using a survey form. Results: On ultrasound, according to the EU-TIRADS classification, 56.8% of nodules presented a low risk of malignancy (EU-TIRADS 3) compared to respectively 19.8%;23% and 2.5% of nodules with zero (EU-TIRADS 2), intermediate (EU-TIRADS 4) and high (EU-TIRADS 5) risk of malignancy. Regarding the performance of this classification, it is sensitive in 37.5% of cases and has a specificity of 78.5% with a PPV (Positive Predictive Value) and a NPV (Negative Predictive Value) respectively of 6.6 % and 91.6%. Furthermore, the bivariate correlations revealed that the size of the nodule was significantly associated with the malignancy of the nodule (p = 0.014) and the calculated value of the Yule’s Q coefficient (0.375) reflects a moderate intensity of the connection between the EU-TIRADS and histology. Conclusion: the EU-TIRADS classification, due to its excellent NPV, is of great interest for the management of thyroid nodules at the CNHU-HKM of Cotonou and at the CHUZ of Suru-Léré. In view of this, particular emphasis must be placed on its regular and rigorous use.

Core needle biopsy for thyroid nodules assessment-a new horizon?

Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.

Treatment of 198 Cases of Thyroid Nodules with Sanying Capsule Combined with Xiaoying Patch

[Objectives]To observe the clinical efficacy of Sanying capsule combined with Xiaoying Patch in treating thyroid nodule(TN).[Methods]Two groups were treated similarly,with 200 cases in the control group undergoing basic treatment for 12 weeks and 198 cases in the observation group receiving Sanying capsule combined with Xiaoying patches for the same duration.The clinical symptoms,number of nodules,diameter of the largest nodule,and maximum reduction of nodules were observed before and after treatment.A control analysis was performed,and the underlying mechanisms were explored.[Results]The primary symptoms of the observation group exhibited a more favorable improvement than those of the control group.Additionally,the number of nodules decreased,the diameter of the largest nodule decreased,and the maximum reduction of nodules decreased in both groups following treatment.However,the observation group demonstrated a more pronounced improvement than the control group(P<0.05).[Conclusions]The combination of Sanying capsule and Xiaoying patch has been demonstrated to be an effective treatment for TN,with a high degree of reliability in terms of safety.

Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai,China

Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.

Molecular Diagnosis of Thyroid Nodules and Its Future Implications for the Management of Thyroid Cancer

Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.

Management Approach to Thyroid Nodules

Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules are benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultrasound, fine needle aspiration biopsy (FNAB), molecular testing, and thyroglobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.

Diagnostic Value and Misdiagnosis Analysis of Conventional Ultrasonography Combined with Contrast-Enhanced Ultrasonography in Thyroid Nodules

Objective:To explore the diagnostic value of conventional ultrasonography combined with contrast-enhanced ultrasonography in thyroid nodules.Methods:From June 2021 to July 2022,163 patients with thyroid nodules enrolled in our hospital were selected as research subjects.After pathological diagnosis,24 cases were malignant thyroid nodules,and 139 cases were benign thyroid nodules.The diagnosis rate of malignant and benign thyroid nodules was observed and analyzed,with 95%CI.Results:Among them,the malignant and benign detection rates of routine ultrasound were 88.63%and 75.00%,respectively,and the malignant and benign detection rates of contrast-enhanced ultrasound were 81.82%and 81.25%,respectively.The malignant and benign detection rates of conventional ultrasound combined with contrast-enhanced ultrasound were 93.18%and 87.50%,respectively,and the 95%CI was greater than 0.7.Conclusion:Conventional ultrasound combined with contrast-enhanced ultrasound can help improve the diagnostic accuracy of benign and malignant thyroid nodules and reduce the misdiagnosis rate.

The Reliability of Ultrasound Diagnosis in Differentiating Malignant from Benign Thyroid Nodules Using TI-RADS Selection Followed by FNA

Context: Diagnostic imaging has increased the rate of thyroid nodules detection and improved utilization of fine-needle aspiration (FNA). Objective: This study aims to demonstrate the effects of the most reliable non-invasive technique on thyroid nodules. Methods: Between 2016 and 2020, 190 patients with 214 nodules visiting King Khalid University Hospital were randomly selected and retrospectively reviewed. Following the ACR TI-RADS recommendations for FNA and correlating cytology reports. Two expert radiologists with ultrasonographic imaging experience re-evaluated and reviewed the images. 88 nodules (41%) in 79 patients were excluded because the nodule size was smaller than the FNA recommended size. Results: Following the ACR TI-RADS for FNA recommended selection, 27 nodules (21.4%) out of the recommended 126 nodules were consistent with malignancy in cytology, with overall mean sensitivities, specificities, accuracies, precisions, and negative predictive values (NPV) of 96.4%, 40.7%, 48.7%, 28.4%, and 98.6% respectively. The nodules were subdivided into the TI-RADS 3, 4, and 5. Conclusion: In conclusion, ACR TI-RADS is feasible, reliable, and well structured, easily applicable in thyroid nodules reporting. ACR TI-RADS can eliminate many unnecessary FNAs, providing a decline in costs and complications. We recommend the ACR TI-RADS in our radiology department to eliminate reporting discrepancies and cut costs, thereby standardizing the reports, improving intra-user agreements, and improving overall patients’ health care.

Electronic Synoptic Reporting of Thyroid Nodules: Potential for Reduction in Number of Patients Undergoing Thyroid Nodule Biopsies

Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.

Cutaneous nodules and a novel GNAS mutation in a Chinese boy with pseudohypoparathyroidism type Ia: A case report and review of literature

BACKGROUND Pseudohypoparathyroidism type Ia(PHP Ia) is a rare hereditary syndrome, and patients with early PHP Ia are generally not diagnosed based on the presentation of cutaneous nodules as the main clinical feature. Here, we describe a Chinese boy with PHP Ia in whom the main clinical feature was cutaneous nodules, and the patient exhibited a novel GNAS mutation.CASE SUMMARY A 5-year-old boy presented with a 5-year history of cutaneous nodules scattered over his entire body. The patient had a short stature, round face, short neck, and slightly flattened nose;he also had multiple hard papules and cutaneous nodules scattered over his entire body. The patient had a significantly elevated parathyroid hormone level. His serum calcium level was reduced, while his serum phosphorus level was increased and his serum thyroid-stimulating hormone level was elevated. Skin biopsy showed osteoma cutis in subcutaneous tissue. Sanger sequencing revealed a frameshift mutation, c.399 del T(p.Ser133 Argfs*2) in exon 5 of the GNAS gene. The patient was diagnosed with PHP Ia and subclinical hypothyroidism. He was given 1,25-dihydroxyvitamin D,calcium carbonate, and synthetic L-thyroxine. After 3 months of treatment, the patient’s parathyroid hormone level decreased, and his serum calcium and serum phosphorus levels were normal. Moreover, his thyroid-stimulating hormone level decreased.CONCLUSION These findings can help dermatologists to diagnose PHP Ia in patients with cutaneous nodules as the main early clinical feature.

Prevalence of Thyroid Nodules and Its Relationship with Iodine Status in Shanghai:a Population-based Study

Objective This study was designed to evaluate the prevalence of thyroid nodules（TNs） and its relationship with urine iodine concentrations（UICs） after the regional rapid economic growth and lifestyle changes. Methods A cross-sectional survey was conducted in the general population aged 15-69 years. A questionnaire regarding general and personal characteristics and relevant information was administered. Ultrasonography of the thyroid was performed, and serum triiodothyronine（T3）, tetraiodothyronine（T4）, serum thyroid stimulating hormone（TSH）, free triiodothyronine（FT3）, free tetraiodothyronine（FT4）, thyroglobulin antibody（Tg Ab）, thyroid peroxidase antibody（TPOAb）, and TSH receptor antibody（TRAb） levels were measured for each individual subject. Results The prevalence rates of TNs in the whole population, females and males were 27.76%, 34.04%, and 21.60%, respectively. The prevalence of multiple nodules increased with age, whereas the prevalence peaks differed between males and females. The median UICs in the whole population and females with non-TNs were higher than those of subjects with TNs（P=0.0035, P=0.0068）. The median UICs in subjects with a single TN were higher than those in subjects with multiple TNs（P=0.0164, P=0.0127）. The result showed a U-shaped curve relationship between UIC and prevalence of TNs. The prevalence of TNs was the lowest when the UIC was 140-400 μg/L. Conclusion The prevalence of TNs was nearly 30% and increased with age. The relationship between UIC and prevalence of TNs is U-shaped, with an increase in risk when the UIC was 〈140 μg/L and 〉400 μg/L. Very low or high UIC levels need attention and correction.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Perithyroidal hemorrhage caused by hydrodissection during radiofrequency ablation for benign thyroid nodules:Two case reports

BACKGROUND Hydrodissection is a widely used technique during radiofrequency ablation(RFA)for benign thyroid nodules.Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment,routine operation of the remaining needle could cause perithyroidal hemorrhage.In this report,we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle,which have not been reported before.CASE SUMMARY A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules.Considering that their nodules were adjacent to the recurrent laryngeal nerve,the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve.During the procedure,active bleeding near the needle appeared on ultrasonography(US).Although moderate pressure was quickly applied to the neck for several minutes,contrast-enhanced US(CEUS)still showed an active hemorrhage.A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding,and the procedure was finally confirmed to be successful by CEUS,without other complications.CONCLUSION Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage.The timely recognition of this acute hemorrhage could help in the timely control of the bleeding,and CEUS-guided ablation of the bleeding point could be useful.

Diagnostic Value of Dual-Energy CT in Differentiating Malignant and Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

Objectives: To evaluate the diagnostic performance of the quantitative iodine parameters, including Iodine Concentration (IC), Normalized Iodine Concentration (NIC), and λHU, in distinguishing malignant and benign thyroid nodules. Methods: Relevant studies were searched from Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure database and other complementary sources from inception to May 20, 2020. Study selection, data extraction, quality assessment, and data analyses were performed following the Cochrane standards and the PRISMA-DTA guideline. Results: Eight studies were included (595 patients with 737 thyroid nodules). The pooled sensitivity, specificity and summary diagnostic odds ratio of IC were 79% (95% CI: 69% - 86%), 76% (95% CI: 65% - 84%) and 11 (95% CI: 5 - 27) respectively;those of NIC were 78% (95% CI: 70% - 85%), 80% (95% CI: 74% - 85%) and 15 (95% CI: 9 - 24) respectively;those of λHU were 80% (95% CI: 71% - 87%), 77% (95% CI: 70% - 83%) and 14 (95% CI: 8 - 24) respectively. Conclusion: DECT can be a potential evaluation tool for thyroid nodules. The NIC may be the most sensitive iodine parameter and could be comparable between different DECT machines in thyroid nodule assessment.

The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

Assessment of Malignancy Risk in Thyroid Nodules Using a Practical Ultrasound Predictor Model: “Alpha Score”

Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of &ge;10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 &plusmn;1.87 vs. 3.74 &plusmn;1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.

The Research of Automatic Classification of Ultrasound Thyroid Nodules

This paper proposes a computer-aided diagnosis system which can automatically detect thyroid nodules (TNs)and discriminate them as benign or malignant. The system firstly uses variational level set active contour withgradients and phase information to complete automatic extraction of the boundaries of thyroid nodules images.Then according to thyroid ultrasound images and clinical diagnostic criteria, a new feature extraction methodbased on the fusion of shape, gray and texture is explored. Due to the imbalance of thyroid sample classes, thispaper introduces a weight factor to improve support vector machine, offering different classes of samples withdifferent weights. Finally, thyroid nodules are classified and discriminated by the improved support vector machine.Experiments show that the efficiency of discrimination on benign and malignant thyroid nodules is improved.

Early warning study of color doppler ultrasound in children with thyroid nodules and thyroid cancer

Objective: To study the diagnostic value of color doppler ultrasound in children with thyroid nodules and thyroid cancer. Methods: A total of sixty children with thyroid nodules treated in our hospital from March 2017 to March 2018 were selected for study. All patients underwent color Doppler ultrasound diagnosis. According to the diagnostic data, benign thyroid nodules and thyroid cancer were analyzed. The nodule nature was grouped into benign nodules group and malignant nodules group. The aspect ratio and boundary of the two groups were compared in blurring, calcification, blood flow signal classification, etc. Results: A total of 95 nodules were diagnosed by color doppler ultrasonography in 60 cases of thyroid nodules. 49 cases were benign nodules. There were 80 nodules, accounting for 82.11%, 11 cases of thyroid cancer, and 15 nodules. Accounted for 15.79%. Biopsy puncture pathology confirmed 77 benign nodules and 18 malignant nodules. The pathological results were gold standard. The specificity of color Doppler ultrasound was 90%, the sensitivity was 66.67%, and the accuracy of ultrasound diagnosis was 86.32%.The two nodules were statistically significant in terms of boundary, aspect ratio, calcification, echo, and resistance index (P<0.05), but the end-diastolic blood flow velocity (EDV) and peak systolic blood flow velocity ( There was no statistical difference between the PSV levels (P>0.05).Conclusion: Color Doppler ultrasound has the advantages of simple operation, high accuracy, non-invasive and painless, and reproducible detection. The high-frequency probe can clearly display changes such as minute lesions, blood flow signals, echoes, calcifications, etc., and can diagnose thyroid cancer in time. It provides a favorable basis for clinical treatment and has important clinical warning value, especially for children with thyroid examination.

Reliability of Thyroid Imaging Reporting and Data System(TIRADS)Classification in Differentiating Benign from Malignant Thyroid Nodules

Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRADS) classifications have been developed with main goal to standardize reporting and facilitate communication between practitioners, and to indicate when fine-needle aspiration biopsy (FNAB) should be performed. Objective: To determine the reliability of Russ’ modified TIRADS classification in predicting thyroid malignancy. Materials and Methods: It was a cross sectional study carried out at Centre Hospitalier de Lagny, Marne La Vallée (France). Consecutive records of patients with focal thyroid nodules on ultrasound (US) for which US-guided FNAB was performed and pathology results were available, from January 2007 to August 2012, were selected for review. The risk of malignancy of each TIRADS category was determined and correlation with pathology assessed. Statistical performances of some US features were also assessed. The threshold for statistical significance was set at 0.05. Results: A total of 430 records of patients were eligible. Twenty-three out of 430 (5.3%) nodules were malignant. The risk of malignancy of the TIRADS categories were as follows: TIRADS2 0%, TIRADS3 2.2%, TIRADS4A 5.9%, TIRADS4B 57.9%, TIRADS5 100% (Gamma statistic = 0.85;Spearman correlation = 0.30, Pearson’s R = 0.37, p Conclusion: Russ’ modified TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adoption and use.

Differential value of shear wave velocity(SWV)in nodules quantitatively determined by ARFI for benign and malignant thyroid nodules

Objective: To study the differential value of shear wave velocity (SWV) in nodules quantitatively determined by acoustic radiation force impulse (ARFI) for benign and malignant thyroid nodules. Methods: Patients who were diagnosed with thyroid nodules in the People's Hospital of Hai'an County between June 2014 and February 2017 were selected and divided into those with benign thyroid nodules and malignant thyroid nodules according to the biopsy results. Before biopsy, the ARFI ultrasonic elastography was performed to measure SWV, and the biopsy tissue was collected after biopsy to determine the expression of proliferation molecules and invasion molecules. Results: The SWV of malignant thyroid nodules was significantly higher than that of benign thyroid nodules;P53, CyclinG2, E-cadherin, TIMP1 and TIMP3 mRNA expression in malignant thyroid nodules were significantly lower than those in benign thyroid nodules while FOXA1, Survivin, XIAP, Twist and Vimentin mRNA expression were significantly higher than those in benign thyroid nodules;P53, CyclinG2, E-cadherin, TIMP1 and TIMP3 mRNA expression in malignant thyroid nodules with high SWV were significantly lower than those in malignant thyroid nodules with low SWV while FOXA1, Survivin, XIAP, Twist and Vimentin mRNA expression were significantly higher than those in malignant thyroid nodules with low SWV. Conclusion: The SWV of malignant thyroid nodules significantly increases and is closely related to the abnormal proliferation and invasion of cancer cells.