Diagnostic value of multimodal ultrasonography for thyroid nodules in thyroid imaging reporting and data system categories 3 to 5
Objective To assess the value of multimodal ultrasonography for diagnosing thyroid nodules—atypia of un-determined significance(AUS)of thyroid imaging reporting and data system(TI-RADS)categories 3 to 5.Methods A total of 90 AUS thyroid nodules in TI-RADS 3-5 categories from 88 patients underwent conventional ultrasonography,ultra-sound elastography,superb microvascular imaging,and multimodal ultrasonography at the same time.With fine needle as-piration biopsy results as the gold standard,the methods were compared in terms of the sensitivity,specificity,accuracy,false positive rate(FPR),false negative rate(FNR),and area under the receiver operating characteristic curve(AUC)for dia-gnosing thyroid nodules.Results There were no significant differences between patients with benign and those with ma-lignant thyroid nodules in terms of sex,age,and nodule locations(all P>0.05),but the proportion of thyroid nodules≤1 cm in diameter was significantly higher for malignant thyroid nodules than for benign thyroid nodules(χ2=9.610,P=0.002).Compared with benign nodules,malignant nodules were significantly more frequent to have low-level echoes or very low-level echoes,a blurred margin,a vertical diameter/horizontal diameter ratio of>1,and microcalcifications or no calcifica-tions(all P<0.05).An ultrasound elastography score of≥3 and type Ⅲ vascularity on superb microvascular imaging indic-ated a higher possibility of malignant thyroid nodules(both P<0.001).The multivariable logistic regression analysis showed that the size,echogenicity,margin,and vertical diameter/horizontal diameter ratio,and superb microvascular imaging type of thyroid nodules were not significant markers for benign or malignant thyroid nodules(all P>0.05),while microcalcifica-tions/no calcifications and an ultrasound elastography score of≥3 were independent risk factors for malignant AUS nod-ules(both P<0.05).The diagnostic sensitivity,specificity,accuracy,FPR,and FNR of conventional ultrasonography for AUS nodules were 91.30%,71.40%,62.70%,28.60%,and 8.70%,respectively;the values for ultrasound elastography were 85.50%,66.70%,52.20%,33.30%,and 14.50%,respectively;the values for superb microvascular imaging were 66.70%,76.20%,42.90%,23.80%,and 33.30%,respectively;and the values for multimodal ultrasonography were 75.20%,92.50%,67.70%,24.80%,and 7.50%,respectively.For distinguishing between benign and malignant AUS nodules,the AUC values of conventional ultrasonography,ultrasound elastography,superb microvascular imaging,and multimodal ultrasonography were 0.866,0.745,0.774,and 0.918,respectively.Conclusion Multimodal ultrasonography shows better diagnostic effic-acy for AUS nodules of TI-RADS 3-5 compared with conventional ultrasonography,ultrasound elastography,and superb mi-crovascular imaging,which can facilitate the malignancy risk stratification and management of AUS thyroid nodules.
Thyroid noduleMultimodal ultrasonographyUltrasound elastographySuperb microvascular imagingDia-gnostic value
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