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.

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.

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.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

Clinical study of preoperative fT4/fT3 quotient and thyroid function test in distinguishing benign from malignant thyroid nodules

Objective:To analyze the clinical and pathological characteristics of thyroid nodules and to explore the related risk factors of malignant thyroid nodules.Methods: According to the criteria of inclusion and exclusion, a total of 283 patients with thyroid nodules during January 2015 and December 2017 were divided into benign group (benign nodule,n =172) and malignant group (malignant nodule,n = 111) based on postoperative histopathological results. The age, sex, serum thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), thyroid stimulating hormone (TSH), free thyroxine (fT4), free three iodine thyroxine (fT3) and fT4/ fT3 ratio were subjected to univariate analysis, and the risk factors of malignant thyroid nodule were screened by multivariate logistic regression analysis.Results:Univariate analysis showed that age, TgAb, fT4 (P < 0.05) and fT4/ fT3 quotient (P < 0.01) were significantly different between the two groups. The fT4/fT3 quotient is a risk factor of malignant nodules. Multivariate logistic regression analysis indicated that the risk factors of malignant thyroid nodule were age (0R: 0.934,95% CI:0.911-0.957), TgAb(0R: 2.069,95% CI: 1.008-4.247) and fT4 (0R: 1.206,95% CI: 1.038-1.401).Conclusion: The fT4/fT3 quotient has important diagnostic value in differentiating benign and malignant thyroid nodules. When fT4 / fT3 > 3, it increases the risk of malignancy. The age, TgAb and fT4 are independent risk factors for malignant thyroid nodule, which is of great value in distinguishing benign from malignant thyroid nodules.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

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).

Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients

Background： The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients. Methods： In all, 762 patients with thyroid nodules （424 malignant and 338 benign） underwent ultrasound （US） check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic （ROC） analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations lbr prediction of malignancy. Results： Patients with malignant nodules were younger and without obvious risk history than those in the benign group （P 〈 0.001, P = 0.93 ）. No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components （89.7%） and hypoechogenicity （89.2%） and the specificity of taller-than-wide shape （98.5%） and microcalcifications （90.6%） were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval （C1） of areas under tile curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations （95% CI： 0.850 0.901）. Conclusions： We should be alert with taller-than-wide shape and microcalcifications, lntranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients.

Correlation of BRD4 and Skp2 expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with the pathological features of nodules

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.

Bethesda System for Reporting Thyroid Cytopathology:A three-year study at a tertiary care referral center in Saudi Arabia

AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system. METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients(15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology. Age, gender, cytological features and histological types of the thyroid cancer were collected from patients' medical chart and cytopathology reports. RESULTS There were 124 total cases of malignancy on resection, giving an overall surgical yield malignancy of 33.6%.Majority of the thyroid cancer nodules(n = 57, 46%) in Bethesda VI category followed by Bethesda IV(n = 25, 20.2%). Almost 40% of the cancer nodules in 31-45 age group in both sex. Papillary thyroid carcinoma(PTC) was the most common form of thyroid cancer among the study population(111, 89.6%) followed by 8.9% of follicular thyroid carcinoma(FTC), 0.8% of medullary carcinoma and 0.8% of anaplastic carcinoma. Among the Bethesda IV category 68% thyroid nodules were PTC and 32% FTC. CONCLUSION The malignancy values reported in our research were constant and comparable with the results of other published data with respect to the risk of malignancy. Patients with follicular neoplasm/suspicious for follicular neoplasm and suspicious of malignancy categories, total thyroidectomy is indicted because of the substantial risk of malignancy.

甲状腺结节超声恶性危险分层指南对甲状腺乳头状癌的诊断价值:C-TIRADS与ATA指南比较

目的探讨甲状腺结节超声恶性危险分层中国指南(C-TIRADS)和美国甲状腺协会(ATA)指南对甲状腺乳头状癌(PTC)的诊断价值。资料与方法回顾性收集2019年7月—2021年5月联勤保障部队第九〇九医院甲状腺结节术后且有明确病理结果的259例患者(339个结节),分为甲状腺良性结节组150例(210个结节)和PTC组109例(129个结节),分析两组一般资料和结节声像图特征,分别用两种指南对结节进行分类并与手术病理结果进行对照,绘制受试者工作特征曲线评价两种指南对PTC的诊断价值。结果两组恶性声像图特征中,实性、边缘模糊/不规则或甲状腺外侵犯、垂直位、低或极低回声、微钙化差异有统计学意义(χ^(2)=123.67、132.71、103.82、4.58、137.93,P均<0.05),以PTC组多见;与C-TIRADS不同,ATA指南对61个结节(61/339,17.99%)分类不明确;C-TIRADS和ATA指南的曲线下面积分别为0.952(0.924~0.972)、0.942(0.911~0.964),差异无统计学意义(Z=0.943,P=0.346);两者的最佳截断值为4b类和高度可疑,C-TIRADS的敏感度最高[0.930(120/129)比0.822(106/129)],ATA指南的特异度最高[0.857(180/210)比0.943(198/210)],差异均有统计学意义(χ^(2)=6.99、8.57,P均<0.01),两组准确度[0.885(300/339)比0.897(300/339)]差异无统计学意义(χ^(2)=0.24,P=0.622)。结论C-TIRADS和ATA指南对PTC均有很高的诊断效能,但C-TIRADS适用于所有甲状腺结节的声像图表现,且受超声医师临床经验影响小,更易在临床推广使用。

实时剪切波弹性成像联合超声造影参数在鉴别甲状腺实性结节良恶性的诊断价值研究

目的 评估实时剪切波弹性成像(SWE)杨氏模量联合超声造影(CEUS)参数在鉴别甲状腺结节良恶性中的诊断价值。方法 以2020年6月至2022年11月在宝鸡市人民医院经细针穿刺活检或手术病理证实的甲状腺结节病人为研究对象,按照研究目标设定的纳入/排除标准,最终纳入106例共106个结节,行常规超声及SWE检查,记录结节超声特征及弹性参数,后行CEUS检查,并对结节动态造影图像进行定量参数分析,获取造影时间-强度曲线(TIC)图及相关CEUS参数。比较SWE参数Еmax、Еmin、Еmean与CEUS参数PI、TTP、MTT、超声造影TIC曲线下面积(AUC)及联合参数在鉴别甲状腺结节良恶性中的诊断价值。结果 106例甲状腺结节中,甲状腺良性结节(TBN)组60例和恶性结节(TMN)组46例;两组结节一般资料比较中,病人年龄平均值TBN组(42.37±5.54)岁与TMN组(39.56±4.69)岁相比差异有统计学意义(P<0.05),结节血流分布差异有统计学意义(P<0.05);两组结节SWE杨氏模量Emax、Emin、Emean平均值中,TBN组平均值分别为(39.29±12.59)Kp、(14.19±4.60)Kp、(23.01±7.93)Kp,TMN组平均值分别为(104.35±35.62)Kp、(35.09±17.53)Kp、(62.13±22.94)Kp,两组相比差异有统计学意义(P<0.05);两组结节CEUS定性及定量各参数PI、TTP、AUC平均值中,TBN组各参数平均值分别为(45.88±4.22)dB、(22.02±1.97)s、(4177.58±426.29)dB·s,TMN组各参数平均值分别为(35.64±4.16)dB、(24.98±3.91)s、(3280.94±315.76)dB·s,TMN组PI、AUC均低于TBN组,而TMN组TTP长于TBN组,两组相比差异有统计学意义(P<0.05);SWE及CEUS参数联合诊断受试者操作特征(ROC)曲线下面积(AUC)、准确性及对应的灵敏度、特异度均高于各参数单独诊断,且均差异有统计学意义(P<0.05)。SWE各参数单独及联合诊断ROC曲线成对比较,Еmax比Еmin、Еmean比Еmin成对比较差异有统计学意义(Z=2.60、3.00,P<0.05)。CEUS各参数单独及联合诊断ROC曲线成对比较,TTP与联合诊断成对比较差异有统计学意义(Z=2.35,P<0.05)。Emean截断值为32.21 KPa时,SWE-Emean联合CEUS特征鉴别甲状腺结节良恶性的诊断效能均优于SWE-Emean或CEUS单独诊断。结论SWE杨氏模量联合CEUS参数可提高甲状腺结节诊断准确性。

深度学习联合C-TIRADS在甲状腺4a类结节风险分层管理的应用

目的探讨深度学习联合中国超声甲状腺影像报告和数据系统(C-TIRADS)在甲状腺4a类结节风险分层管理的应用。方法纳入陕西省人民医院2018年12月~2022年10月收治的179例甲状腺结节患者,依据病理结果分为良性组(n=76)与恶性组(n=103),所有患者均予以超声检查,按照C-TIRADS指南标准、深度学习进行观察诊断。利用多因素Logistic回归分析获取独立预测指标;利用ROC曲线评估预测变量准确性。结果多因素Logistic分析显示,甲状腺结节图像特征的结构、方位、边缘、回声、局灶性强回声及年龄是独立预测甲状腺结节性质的指标(P<0.05)。以病理结果为金标准,深度学习联合C-TIRADS与病理结果完全符合率为96.65%,Kappa值为0.932,一致性好;联合诊断甲状腺4a类结节的符合率、特异度、阳性预测值显著高于深度学习、C-TIRADS(P<0.05)。联合诊断疾病的敏感度、阴性预测值高于深度学习(P<0.001),但与C-TIRADS的差异无统计学意义(P<0.05)。ROC曲线分析显示,C-TIRADS、深度学习及联合诊断的AUC分别为0.873、0.819、0.967;与Az=0.5相比,差异有统计学意义(P<0.001)。结论C-TIRADS在甲状腺4a类结节风险分层管理中敏感性较高,结合深度学习辅助诊断能够准确进行甲状腺结节良恶性鉴别,具备较高诊断效能。

C-TIRADS分类联合剪切波弹性成像鉴别诊断不同大小甲状腺结节的临床价值

目的 探讨C-TIRADS分类联合剪切波弹性成像(SWE)鉴别诊断不同大小甲状腺结节良恶性的临床价值。方法 选取经病理确诊的甲状腺结节患者139例(共139个结节),根据结节大小分为最大径≤10 mm组(58个结节)和最大径>10 mm组(81个结节)。术前均行常规超声检查并进行C-TIRADS分类;SWE获得结节杨氏模量最大值(Emax)和平均值(Emean),比较两组SWE参数的差异。绘制受试者工作特征(ROC)曲线分析C-TIRADS分类、SWE定量参数单独及联合应用鉴别不同大小甲状腺结节良恶性的诊断效能。结果 C-TIRADS分类诊断最大径≤10 mm组结节良性19个,恶性39个;诊断最大径>10 mm组结节良性50个,恶性31个。最大径≤10 mm组、最大径>10 mm组中良性结节与恶性结节Emax、Emean比较,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,C-TIRADS分类联合Emax鉴别最大径≤10 mm结节良恶性的AUC为0.950,均大于二者单独应用(0.866、0.840),差异均有统计学意义(均P<0.05);C-TIRADS分类联合Emax鉴别最大径>10 mm结节良恶性的AUC为0.952,大于Emax(0.777),差异有统计学意义(P<0.05),但与C-TIRADS分类(0.932)比较差异无统计学意义。C-TIRADS 4A类结节中有5个经病理确诊为恶性,其中4个结节的Emax均大于截断值。结论 C-TIRADS分类联合SWE可提高对最大径≤10 mm甲状腺结节良恶性的鉴别诊断效能,SWE可优化C-TIRADS 4A类结节的诊断准确率。

细针穿刺病理检查鉴别甲状腺结节良恶性的价值及其穿刺标本质量的影响因素分析

目的:探讨超声引导下的细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,并分析其穿刺标本质量的影响因素。方法:收集2017年01月至2021年12月于我院行甲状腺结节细针穿刺活检的577例患者临床资料,其中79例(100个结节)接受了甲状腺手术切除并获得组织学病理结果,以手术病理学结果为诊断金标准,分析超声引导下细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,采用二元logistics回归系数分析其标本质量的影响因素。结果:细针穿刺活检恶性病变敏感性为98.48%,特异性为91.18%,准确性为96.00%。细针穿刺活检病理检查与组织学病理检查病理分型结果一致性显示,Kappa值为0.914(P<0.05)。与非优良组相比,优良组诊断敏感性、特异性、准确性更高(P<0.05)。与诊断优良组相比,非优良组>1 cm占比更少,存在钙化占比更多(P<0.05);优良组穿刺标本细胞数量更充足,细胞蜡块制备效果更佳。二元logistics回归系数分析显示,最大直径、钙化是细针穿刺标本质量的重要影响因素(P<0.05)。结论:超声引导下细针穿刺病理检查对甲状腺结节良恶性鉴别及病理分型均体现较高临床价值;高质量样本有助于提高细针穿刺诊断结节良恶性的特异性、敏感性和准确性,最大直径、钙化是穿刺标本质量的影响因素。

DCE-MRI定量参数联合小视野弥散加权成像对甲状腺良恶性结节鉴别的价值

目的探讨动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数联合小视野弥散加权成像在甲状腺良恶性结节鉴别中的应用价值。材料与方法收集2022年1月至2023年10月于滨州医学院附属医院诊治并经手术病理证实为甲状腺结节的患者38例(52个结节),将其分为良性结节组和恶性结节组。术前患者均行3.0 T MRI扫描,包括常规MRI、小视野弥散加权成像(b值取0、800 s/mm^(2))和DCE-MRI检查,并测量其表观弥散系数(apparent diffusion coefficient,ADC)值和DCE-MRI定量参数,包括对比剂容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_(e))。对甲状腺良恶性结节组的ADC、K_(ep)、V_(e)、K^(trans)采用独立样本t检验分析,以P<0.05为差异有统计学意义,后将差异有统计学意义的变量进行逐步logistic回归模型分析,得到甲状腺良恶性结节的独立预测因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析ADC、K^(trans)独立诊断模型及ADC与K^(trans)联合诊断模型的诊断效能。结果良性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.659±0.370)×10^(-3)mm^(2)/s、(0.427±0.214)min^(-1)、(0.966±0.225)min^(-1),恶性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.182±0.195)×10^(-3)mm^(2)/s、(0.178±0.073)min^(-1)、(0.600±0.248)min^(-1)。良性结节组的ADC、K^(trans)、K_(ep)值均高于恶性结节组,差异均有统计学意义(P<0.001)。经过独立样本t检验及逐步logistic回归分析显示,ADC值和K^(trans)差异具有统计学意义(P<0.05),是鉴别甲状腺结节良恶性的独立预测因子。单独ADC值曲线下面积(area under the curve,AUC)为0.915、单独K^(trans)值AUC为0.827。ADC值与K^(trans)联合诊断模型AUC为0.973,较二者单独应用明显增高,联合诊断模型诊断效能最高。经DeLong检验,联合诊断模型与单独K^(trans)诊断差异存在统计学意义(P<0.05)。ADC值与K^(trans)联合诊断模型在鉴别甲状腺良恶性结节中敏感度为97.3%,较ADC、K^(trans)更高,特异度为84.6%,较ADC值更高。结论ADC值和K^(trans)是鉴别甲状腺良恶性结节的重要参数,两者联合诊断可提高临床诊断准确性,为术前诊断提供重要依据。

SWE联合SMI在甲状腺良恶性结节鉴别诊断中的应用

目的探讨剪切波弹性成像(SWE)联合超微血管成像(SMI)技术在甲状腺良恶性结节鉴别诊断中应用的准确性与可行性。方法选取2021年1月至2022年12月我院超声科检出甲状腺结节并接受超声引导细针抽吸活检或术后组织病理完善的190例患者为研究对象,共检出224个甲状腺结节(病理学明确诊断良性结节74个,恶性结节150个)。患者甲状腺均进行超声、SWE和SMI检查,并计算组织杨氏模量相关参数以及微细血流、穿支血管情况。以组织病理结果作为金标准构建受试者操作特征(ROC)曲线,分析SWE联合SMI对甲状腺良恶性结节鉴别诊断的效果,比较不同检查方法在甲状腺结节诊断中的效能差异。结果甲状腺良性与恶性结节内部成分、回声、边缘、钙化、纵横比比较均有统计学差异(均P<0.05),但二者平均直径比较无统计学差异(P>0.05)。与甲状腺恶性结节比较,甲状腺良性结节弹性最大值、弹性均值、弹性比率、微血流评分、剪切波峰值速度、剪切波平均速度差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,弹性最大值曲线下面积最大,截断值为29.52 kPa;微血流评分截断值为2.3分。诊断效能分析结果显示,SWE联合SMI的灵敏度与特异度最高,分别为94.67%、94.59%。结论SWE联合SMI可进一步提高甲状腺良恶性结节的诊断效能,并可实现病灶的量化评估与动态观察,具有应用及推广价值。

基于超声图像评估甲状腺和乳腺病变的通用计算方法

甲状腺和乳腺病变是影响女性身心健康的两类常见疾病。为了深入挖掘两类病变在超声图像上的个性差异和共性特征,提出一种通用的计算方法识别甲状腺和乳腺病变。先利用小波包变换将超声图像分解为4个子图;再借助灰度共生矩阵提取不含高频噪声的3个子图的纹理特征;最后利用最大相关最小冗余算法筛选特征,输入4种机器学习模型,完成甲状腺、乳腺结节良恶二分类和四分类。将方法应用于来自不同平台的甲状腺和乳腺超声图像,随机排列交叉验证二分类AUC达到0.88~0.99,准确率ACC达到0.84~0.98,均优于已有研究结果;四分类AUC达到0.95~0.97,ACC达到0.88~0.92,优于深度残差网络ResNet50。基于甲状腺(乳腺)图像训练的四种模型在交叉识别乳腺(甲状腺)良恶结节方面也取得了理想的分类结果,进一步验证了所提方法的稳定性和通用性。同时,T检验结果显示:甲状腺和乳腺恶性结节超声图像的近似子图存在非常显著的纹理差异,垂直细节子图展示出6个潜在的共性特征。

甲状腺影像报告与数据系统联合超声微血管成像对甲状腺结节良恶性的鉴别诊断价值

目的 探讨甲状腺影像报告与数据系统(TI-RADS)联合超声微血管成像(SMI)对甲状腺结节良恶性的鉴别诊断价值。方法 回顾性纳入2021年1月至2023年12月就诊于东莞市东南部中心医院的112例甲状腺结节患者,所有患者术前均进行常规超声检查及SMI检查,依据常规超声行TI-RADS分级。以病理检查为金标准,对比以上两种检查方式单独及联合诊断对甲状腺结节的鉴别价值,绘制受试者操作特征(ROC)曲线验证检查的诊断价值。结果 本研究112例(112个结节)患者中,良性结节70个(62.50%),恶性结节42个(37.50%)。112个结节中,TI-RADS分类诊断为1类、2类、3类、4类及5类结节数分别为11、32、25、16及28个。112个结节中,SMI技术诊断为0、1级、2级及3级的结节数分别为40、25、12及35个。以病理结果为金标准,TI-RADS分类诊断误诊16例,漏诊14例;SMI误诊13例,漏诊8例。二者联合的敏感度及阴性预测值均高于单独TI-RADS分类及SMI技术,差异有统计学意义(P<0.05);二者联合的准确性高于单独TI-RADS分类,差异有统计学意义(P<0.05)。ROC曲线显示,二者联合时对甲状腺恶性结节的诊断价值最高,此时曲线下面积(AUC)为0.874,95%CI为0.771~0.905。结论 TI-RADS与SMI二者联合能进一步提高甲状腺结节诊断的敏感度与准确性,可为临床医师的医疗决策提供更多参考。

人工智能辅助评分联合剪切波弹性成像鉴别诊断甲状腺良恶性结节的临床价值

目的探讨人工智能辅助评分(AIAS)联合剪切波弹性成像(SWE)鉴别诊断甲状腺良恶性结节的临床价值。方法选取我院经手术或穿刺活检病理确诊的甲状腺结节患者231例,共检出327个结节,其中良性结节135个,恶性结节192个,比较甲状腺良恶性结节SWE参数[应变率比值(SR)]和AIAS的差异。绘制受试者工作特征(ROC)曲线分析SR、AIAS单独及联合鉴别甲状腺良恶性结节的诊断效能。结果甲状腺恶性结节SR和AIAS均明显高于良性结节,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,SR、AIAS鉴别诊断甲状腺良恶性结节的曲线下面积分别为0.885、0.845,灵敏度分别为75.00%、78.12%,特异度分别为97.78%、93.33%;二者联合鉴别诊断甲状腺良恶性结节的曲线下面积为0.917,灵敏度为82.81%,特异度为91.11%,均高于其单独应用,差异均有统计学意义(均P<0.05)。结论AIAS联合SWE在鉴别诊断甲状腺良恶性结节中有一定的临床价值。