目的目前临床上超声甲状腺影像报告和数据系统(throid imaging reporting and date system,TI-RADS)4类甲状腺结节的恶性率为5%~80%,波动范围较大,术前如何更好的评估结节性质尤为重要。本研究拟结合临床特征与超声征象建立预测模型,并...目的目前临床上超声甲状腺影像报告和数据系统(throid imaging reporting and date system,TI-RADS)4类甲状腺结节的恶性率为5%~80%,波动范围较大,术前如何更好的评估结节性质尤为重要。本研究拟结合临床特征与超声征象建立预测模型,并探讨其应用价值。方法收集2017年1月至2021年12月武汉科技大学附属孝感医院超声诊断TI-RADS 4类甲状腺结节患者454例(494个结节)的临床资料。依据术后病理结果进行分组,对纳入变量进行多因素分析,并对每项独立预测指标进行赋值,计算不同分值下的TI-RADS 4类甲状腺结节恶性率,建立相应预测模型并验证。结果454例(494个)TI-RADS 4类甲状腺结节,恶性诊断率为78.3%(387/494),其中TI-RADS 4A恶性率为68.3%(157/230),TIRADS 4B恶性率为87.1%(222/255),TI-RADS 4C恶性率为88.9%(8/9)。按照年龄进行分层分析,年龄≤35岁与>35岁患者中,结节恶性率分别为90.2%(55/61)、75.8%(298/393),二者比较差异有统计学意义(P<0.05);按照结节大小进行分层分析,结节≤1 cm与>1 cm患者中,结节恶性率分别为85.7%(276/322)、64.5%(111/172),二者比较差异有统计学意义(P<0.05)。多因素分析提示年龄、微钙化、纵横比、低回声、结节边界、结节大小、促甲状腺激素(thyrotrophin,TSH)是鉴别TI-RADS 4类甲状腺结节良恶性的独立预测指标(P<0.05)。建立TI-RADS 4类甲状腺结节预测指数(predictive index of TI-RADS 4 type thyroid nodule,PI-TI-RADS 4)预测模型提示,0~1分为TI-RADS 4类甲状腺结节恶性低风险,2~3分为中风险,4分及以上为高风险。该模型内部验证ROC曲线面积为0.880[95%CI为(0.843,0.917),P<0.05],敏感度及特异度分别为84.7%、79.2%,具有较好预测效能。结论年龄、结节大小、微钙化、纵横比、低回声、结节边界、TSH是TIRADS 4类甲状腺结节癌变的独立预测指标。预测模型有助于TI-RADS 4类甲状腺结节精准分类。展开更多
Objective:To study the correlation of bromodomain-containing protein 4(BRD4)and S-phase kinase-associated protein 2(Skp2)expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with ...Objective:To study the correlation of bromodomain-containing protein 4(BRD4)and S-phase kinase-associated protein 2(Skp2)expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with the pathological features of nodules.Methods:The tissues obtained in ultrasound-guided thyroid nodule fine needle aspiration biopsy in our hospital between March 2015 and March 2018 was selected and divided into malignant group and benign group according to the pathological results,and the expression levels of BRD4,Skp2,proliferation genes and angiogenesis genes were detected.Results:The BRD4 and Skp2 mRNA expression in thyroid nodules of the malignant group were significantly higher than those of the benign group,and the BRD4 and Skp2 mRNA expression in the malignant group of thyroid nodules with TNM III-IV,capsular invasion and lymph node metastasis were significantly higher than those in the thyroid nodules with TNM I-II,without capsular invasion and without lymph node metastasis;cyclin D1(CCND1),β-catenin,proliferation cell nuclear antigen(PCNA),vascular endothelial growth factor(VEGF),endothelial cell specific molecule-1(ESM-1),Survivin and cyclooxygenase 2(COX2)mRNA expression in thyroid nodules of the malignant group were obviously higher than those of the benign group and positively correlated with BRD4 and Skp2 while cyclin G2(CCNG2)and endostatin(ES)mRNA expression were significantly lower than those of the benign group and negatively correlated with BRD4 and Skp2.Conclusion:The high expression of BRD4 and Skp2 in malignant thyroid nodules is correlated with the pathological changes and can change the expression of proliferation genes and angiogenesis genes.展开更多
Background:Three-dimensional shear wave elastography(3D-SWE)is a promising method in distinguishing benign and malignant thyroid nodules.By combining with conventional method,it may further improve the diagnostic valu...Background:Three-dimensional shear wave elastography(3D-SWE)is a promising method in distinguishing benign and malignant thyroid nodules.By combining with conventional method,it may further improve the diagnostic value.The study aimed to assess the diagnostic value of American College of Radiology(ACR)thyroid imaging reporting and data system(TI-RADS)combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.Methods:All nodules were examined by conventional ultrasonography,ACR TI-RADS classification,and 3D-SWE examination.Conventional ultrasonography was used to observe the location,size,shape,margin,echogenicity,taller-than-wide sign,microcalcification,and blood flow of thyroid nodules,and then ACR TI-RADS classification was performed.The Young’s modulus values(3D-C-Emax,3D-C-Emean,and elastography standard deviation[3D-C-Esd])were measured on the reconstructed coronal plane images.According to the receiver operating characteristic(ROC)curve,the best diagnostic efficiency among 3D-C-Emax,3D-C-Emean,and 3D-C-Esd was selected and the cut-off threshold was calculated.According to the surgical pathology,they were divided into benign group and malignant group.And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups.On this basis,3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.Results:Of the 112 thyroid nodules,62 were malignant and 50 were benign.The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane(3D-C-Emax)was 51.5 kPa and the area under the curve(AUC)was 0.798.The AUC,sensitivity,specificity,and accuracy of conventional ACR TI-RADS were 0.828,83.9%,66.0%,and 75.9%,respectively.The AUC,sensitivity,specificity,and accuracy of combined ACR TI-RADS were 0.845,90.3%,66.0%,and 79.5%,respectively.The difference between the two AUC values was statistically significant.Conclusions:Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS.The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements.It can be used as an effective method in the diagnosis of thyroid nodules.展开更多
基金Hubei Provincial Natural Science Foundation Project.Project No:WJ2015MB125.
文摘Objective:To study the correlation of bromodomain-containing protein 4(BRD4)and S-phase kinase-associated protein 2(Skp2)expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with the pathological features of nodules.Methods:The tissues obtained in ultrasound-guided thyroid nodule fine needle aspiration biopsy in our hospital between March 2015 and March 2018 was selected and divided into malignant group and benign group according to the pathological results,and the expression levels of BRD4,Skp2,proliferation genes and angiogenesis genes were detected.Results:The BRD4 and Skp2 mRNA expression in thyroid nodules of the malignant group were significantly higher than those of the benign group,and the BRD4 and Skp2 mRNA expression in the malignant group of thyroid nodules with TNM III-IV,capsular invasion and lymph node metastasis were significantly higher than those in the thyroid nodules with TNM I-II,without capsular invasion and without lymph node metastasis;cyclin D1(CCND1),β-catenin,proliferation cell nuclear antigen(PCNA),vascular endothelial growth factor(VEGF),endothelial cell specific molecule-1(ESM-1),Survivin and cyclooxygenase 2(COX2)mRNA expression in thyroid nodules of the malignant group were obviously higher than those of the benign group and positively correlated with BRD4 and Skp2 while cyclin G2(CCNG2)and endostatin(ES)mRNA expression were significantly lower than those of the benign group and negatively correlated with BRD4 and Skp2.Conclusion:The high expression of BRD4 and Skp2 in malignant thyroid nodules is correlated with the pathological changes and can change the expression of proliferation genes and angiogenesis genes.
基金Pre-research Foundation Project of the Second Affiliated Hospital of Soochow University(No.SDFEYQN1903)
文摘Background:Three-dimensional shear wave elastography(3D-SWE)is a promising method in distinguishing benign and malignant thyroid nodules.By combining with conventional method,it may further improve the diagnostic value.The study aimed to assess the diagnostic value of American College of Radiology(ACR)thyroid imaging reporting and data system(TI-RADS)combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.Methods:All nodules were examined by conventional ultrasonography,ACR TI-RADS classification,and 3D-SWE examination.Conventional ultrasonography was used to observe the location,size,shape,margin,echogenicity,taller-than-wide sign,microcalcification,and blood flow of thyroid nodules,and then ACR TI-RADS classification was performed.The Young’s modulus values(3D-C-Emax,3D-C-Emean,and elastography standard deviation[3D-C-Esd])were measured on the reconstructed coronal plane images.According to the receiver operating characteristic(ROC)curve,the best diagnostic efficiency among 3D-C-Emax,3D-C-Emean,and 3D-C-Esd was selected and the cut-off threshold was calculated.According to the surgical pathology,they were divided into benign group and malignant group.And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups.On this basis,3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.Results:Of the 112 thyroid nodules,62 were malignant and 50 were benign.The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane(3D-C-Emax)was 51.5 kPa and the area under the curve(AUC)was 0.798.The AUC,sensitivity,specificity,and accuracy of conventional ACR TI-RADS were 0.828,83.9%,66.0%,and 75.9%,respectively.The AUC,sensitivity,specificity,and accuracy of combined ACR TI-RADS were 0.845,90.3%,66.0%,and 79.5%,respectively.The difference between the two AUC values was statistically significant.Conclusions:Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS.The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements.It can be used as an effective method in the diagnosis of thyroid nodules.
