Objective To correct the classification of 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules(C-TIRADS)by angio plus planwave ultrasensitive imaging(AP),and to investigate the clinical value in the differential diagnosis of mummified thyroid nodules(MTN)and papillary thyroid carcinomas(PTC).Methods A total of 234 patients with thyroid nodules confirmed by fine needle aspiration or surgical pathology in our hospital and the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively selected,all of which were single lesions,including 112 cases of MTN and 122 cases of PTC,and the two-dimensional ultrasound characteristics and AP blood flow grading were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of C-TIRADS classification for distinguishing MTN and PTC before and after AP correction.Results There were statistically significant differences in markedly hypoechoic,vertical orientation,comet-tail artifacts and AP blood flow grading between the MTN and PTC(all P<0.05),and the AP blood flow grading of MTN was mainly grades 0,Ⅰ,while that of PTC was mainly grades Ⅱ,Ⅲ.There were no significant differences in maximum nodule diameter,solid,ill-defined margin/extrathyroidal extension,suspected microcalcifications and CDFI blood flow grading between the MTN and PTC.Among the 112 MTN,there were 17 nodules in C-TIRADS 4A,45 nodules in C-TIRADS 4B,49 nodules in C-TIRADS 4C,and 1 nodule in C-TIRADS 5.After AP correction,there were 11 nodules in C-TIRADS 3,31 nodules in C-TIRADS 4A,65 nodules in C-TIRADS 4B,4 nodules in C-TIRADS 4C,and 1 nodule in C-TIRADS 5.Among the 122 PTC,there were 13 nodules in C-TIRADS 4A,41 nodules in C-TIRADS 4B,61 nodules in C-TIRADS 4C,and 7 nodules in C-TIRADS 5.After AP correction,there were 3 nodules in C-TIRADS 4A,15 nodules in C-TIRADS 4B,44 nodules in C-TIRADS 4C,and 60 nodules in C-TIRADS 5.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area under the curve of C-TIRADS in distinguishing MTN and PTC before and after AP correction were 55.74%,55.36%,55.56%,57.63%,53.45%,0.570 and 85.25%,95.54%,90.17%,95.41%,85.60%,0.928,respectively,and the differences were statistically significant(all P<0.05).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area under the curve after AP correction for distinguishing nodules with maximum diameter<10 mm and≥10 mm were 98.51%,83.15%,89.74%,81.48%,98.67%,0.927 and 88.37%,91.43%,89.74%,92.68%,86.49%,0.926,respectively,which were higher than those before AP correction(52.75%,49.23%,51.28%,60.00%,42.67%,0.522 and 74.07%,58.82%,64.10%,48.78%,81.08%,0.675),and there were no significant differences in sensitivity and negative predictive value for nodules with maximum diameter≥10 mm before and after AP correction,while there were significant differences in other diagnostic efficacies(all P<0.05).Conclusion AP can clearly show the blood flow characteristics in thyroid nodules,which can significantly improve the differential diagnostic ability of MTN and PTC by correcting C-TIRADS classification,which has a certain clinical application value.
UltrasonographyChinese thyroid imaging reporting and date systemAngio plus planwave ultrasensitive imagingMummified thyroid nodulesPapillary thyroid carcinomas
NETL
NSTL
万方数据
