ObjectiveTo assess the effect of the size of thyroid nodules on the diagnostic rate of ultrasound guided aspiration cytology (US-FNAB). MethodsThe data of 1 142 (performed by two doctors, 571 each) thyroid nodules between March 2011 and April 2014 in our hospital were retrospectively analyzed. Yields of US-FNAB were divided into two levels of adequacy and inadequacy according to the classification standard of the Bethesda system. The thyroid nodules were classified into five groups according to the largest diameter:≤5 mm group, 5-10 mm group,10-20 mm group, 20-30 mm group, and <30 mm group. According to the grouping of the nodules and the efficiency of US-FNAB drawed curve, the adequacy rates of alone and total of two examiners in each group were analyzed, respectively. ResultsThe adequacy rates of US-FNAB of alone and total of two examiners in≤5 mm group, 5-10 mm group,10-20 mm group, 20-30 mm group, and <30 mm group was 68.42%, 83.72%, 86.08%, 84.62%, and 73.53% (examiner 1); 68.75%, 70.53%, 81.05%, 86.15%, and 73.91% (examiner 2); 68.59%, 77.53%, 83.59%, 85.47%, and 73.75% (total of two examiners), respectively. The total adequacy rate of US-FNAB of two examiners in≤5 mm group was lower than that in 10-20 mm group (P<0.001) and 20-30 mm group (P=0.001). The adequacy rate of US-FNAB of examiner 1 in 5-10 mm group was higher than that examiner 2 (P=0.001). ConclusionsThe size of thyroid nodules significantly influences the adequate diagnostic rate of US-FNAB. The adequacy rates of US-FNAB of the largest diameter≤5 mm or <3mm were lower. The low adequacy rate of US-FNAB may be associated with cystic degeneration in the larger nodules.
ObjectiveTo assess the effect of short-axis and long-axis punctures of thyroid nodules on the diagnostic rate of ultrasound guided aspiration biopsy (US-FNAB). MethodsWe retrospectively analyzed the clinical data of 2 686 thyroid nodule patients who underwent US-FNAB between March 2011 and November 2014. The US-FNAB was performed by 5 beginners (571 each for Dr1-Dr4 and 402 for Dr5). Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system:adequacy and inadequacy. Short-axis puncture technique was used by Dr2 and long-axis puncture was performed by the others. According to chronological sequence of thyroid nodules examined, we compared the inadequate diagnostic rate between Dr2 and the others for the first 200 cases and the last 200 cases, respectively. The inadequate diagnostic rate was compared among the 4 doctors who used long-axis punctures for the first 200 cases and the last 200 cases, respectively. ResultsThe inadequacy rate of US-FNAB for Dr2 was higher than that for Dr1, Dr3, Dr4 and Dr5 in the first 200 cases, with statistical significance (P=0.036,<0.001,=0.007 and <0.001, respectively). There was no significant difference in inadequate diagnostic rate among the 4 doctors who used long-axis punctures for the first 200 cases (P=0.033, 0.551, 0.011, 0.122, 0.672 and 0.050). The inadequacy rate of US-FNAB for Dr2 was higher than that for Dr5 and lower than that for Dr4 in the last 200 cases with statistical significance (P=0.027 and 0.003, respectively). The inadequacy rate of US-FNAB for Dr5 was lower than that for Dr3 (P=0.005) and Dr4 (P<0.001) among the 4 doctors who used long-axis punctures for the last 200 cases. ConclusionFor beginners, the inadequacy rate of short-axis puncture is higher than long-axis puncture. We suggest beginners learn long-axis puncture method. There is no significant difference in inadequate diagnostic rate among short-axis and long-axis punctures, when the number of operated cases reaches 200. At this point, the operator can choose either way to puncture according to the disease condition or personal interests.
Objective To summary the change of surgical approaches, indications, contraindications, and complications of endoscopic thyroidectomy. Methods Endoscopic thyroidectomy related literatures at home and abroad were collected to summary the change of surgical approaches, indications, contraindications, and complications of it. Results The approaches of endoscopic thyroidectomy had their own advantages, wherein breast and complete areola approaches were mainstream surgical procedures; the indications were closely correlated with surgeons and devices, and there were no uniform indications yet. With the advance in endoscopic techniques, the contraindications would be gradually resolved, and the assistance of new devices and the accumulation of experience reduced the incidence of surgical complications, but there were still probability of occurrence of such complications. Conclusion Endoscopic thyroidectomy is the main means of treating thyroid nodules, which will be more widely used with the advance in techniques, the innovation of devices, the expansion of indications as well as the overcoming of contraindications.
Objective To evaluate the diagnostic performance of thyroid imaging reporting and data system (TI-RADS)classification and elastography in differentiating benign and malignant thyroid nodules according to size. Methods A total of 222 thyroid nodules (209 cases) with solid or predominantly solid internal contentdiagnosed at pathological findings were enrolled in this study, all the 209 cases underwent surgery in our hospital from Jan.2014 to Jun.2014. The diagnostic performance of TI-RADS classification and elastography in differentiating benign and malignant thyroid nodules according to size nodules were evaluated (for≤1 cm and > 1 cm respectively). Results By using TI-RADS category and elastography, 178 thyroid nodules were diagnosed as malignant nodules, and 44 thyroid nodules were diagnosed as benign nodules. The high predictive factors for malignant thyroid nodules of > 1 cm were irregular shape(OR=6.376), microcalcification(OR=21.525), and capsule invasion(OR=3.852), P < 0.05. The factors for thyroid nodules of≤1 cm were anteroposterior to transverse diameter ratio≥1(OR=3.406), capsule invasion (OR=3.922), and high elastography score(OR=1.606), that suggested the possibility of malignant (P < 0.05). For nodules of > 1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of TI-RADS combining with elastography were 98.3%(59/60), 68.6%(24/35), 87.4%(83/95), 84.3%(59/70), 96.0% (24/25), and 66.9% respectively; for nodules of≤1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index were 98.5%(67/68), 30.5%(18/59), 66.9%(85/127), 62.0%(67/108), 94.7%(18/19), and 29.0% respectively. Conclusion TI-RADS category combined with elastography for diagnosis of thyroid nodules in different size has just a bit differently diagnostic indicators, but that play a high diagnostic performance on the thyroid nodules with maximum diameter > 1 cm.
ObjectiveTo investigate the prevalence of thyroid nodules and its influencing factors among medical staff of a hospital in Hengshui. MethodsA total of 2 190 medical workers in a hospital in Hengshui who underwent physical examinations in the Medical Examination Center of Harrison International Peace Hospital from January 2012 to July 2013 were included as the study subjects. Through physical examination, thyroid ultrasonography and questionnaire, we collected data and investigated the prevalence of thyroid nodules and its influencing factors. ResultsThe prevalence rate of thyroid nodules was 39.45% (864/2 190) in these medical staff. The prevalence rates of thyroid nodules in males and females were 32.34% (238/736) and 42.92% (624/1 454), respectively, with statistically significant difference between them (χ2=22.913, P<0.001). With increasing age, the prevalence of thyroid nodules increased gradually, and the prevalence of the same sex increased gradually too (P<0.001). The prevalence rate of women was significantly higher than that of men for each age group (P<0.05). Among the 864 subjects, there were 550 (63.66%) with multiple nodules and 314 (36.34%) with solitary nodules; there were 454 (52.55%) with nodules in both lobes of thyroid, 238 (27.54%) with nodules in the right lobe of thyroid, and 172 (19.91%) with nodules in the left lobe of thyroid; there were 504 (58.33%) with solid modules, 172 (19.91%) with cystic nodules, 114 (13.19%) with solid and cystic nodules, and 74 (8.56%) with calcification. Logistic regression analysis showed that gender, age, educational degree, drinking history, taste habit, stress, agitation were correlated with the development of thyroid nodules. ConclusionThe prevalence of thyroid nodules is high among medical staff of this hospital. Thyroid nodules can be prevented through healthy lifestyle, limiting alcohol intake, emotional control, and relieving stress. Early diagnosis and early treatment should be done to prevent the development and spread of thyroid nodules.
ObjectiveTo investigate the clinical value of real-time elastosonography in diagnosis of thyroid nodules. MethodsThe clinical date of 168 patients with thyroid nodules, admitted to our hospital from June 2009 to December, were retrospectively analyzed with pathological findings as the reference standard． The findings on elastography were classified into five grades: grade 0 to Ⅳ. The nodules with grade less than Ⅱ were diagnosed as benign, otherwise more than Ⅲ were diagnosed as malignancy. ResultsThere were 208 nodules in 168 patients: nodular goiter was in 125 cases, thyroid adenoma in 36 cases, thyroid malignant tumor in 41 cases including 39 cases for thyroid papillary carcinoma, 1 case for thyroid medullary carcinoma, 1 case for thyroid non-Hodgkin lymphoma. Other nodules were in 6 cases, including diffuse toxic goiter in 1 case, local lymphocytic thyroiditis in 3 cases, and subacute granulomatous thyroiditis in 2 cases. There were 148 thyroid nodules in grade 0-Ⅱ and 60 nodules in grade Ⅲ-Ⅳ. According to the pathological findings, 97.3%(144/148) thyroid nodules of grade 0-Ⅱ were benign, however, 38.3% (23/60) of grade Ⅲ-Ⅳ were benign. Furthermore, 2.7% (4/148) thyroid nodules of grade 0-Ⅱ were malignancy, while 61.7% (37/60) of grade Ⅲ-Ⅳ were malignancy. The sensitivity， specificity, and accuracy of the real-time elastosonography in diagnosis of thyroid nodules was 90.2%(37/41), 86.2%(144/167), and 87.0%(181/208), respectively. ConclusionReal-time elastosonography can reflect the relative hardness of thyroid nodules and provide useful information for diagnosis, which is helpful in differentiating benign and malignant thyroid nodules.
ObjectiveTo explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules. MethodsThe clinical data of 347 patients with thyroid nodules who underwent ultrasoundguided CNB were retrospectively analyzed, and the results of CNB pathology were compared with postoperative wax pathology results. ResultsAll patients completed CNB successfully and satisfaction rate for tissue samples was 100%. After CNB, local hematoma occurred in two cases and relieved by conservative therapy. The CNB pathology results of 347 cases of patients were as follows: 117 cases were malignancy, including papillary thyroid cancer in 115 cases, undifferentiated adenocarcinoma in 1 case, and squamous cell carcinoma in 1 case; 230 cases were benign, including thyroiditis in 53 cases, and nodular goiter in 141 cases, adenoma in 16 cases, and nodular goitre coexisting thyroiditis in 20 cases. In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease, the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases. The diameter of thyroid nodules were not more than 0.5 cm in 4 cases, 0.5-1.0 cm in 59 cases, 1-2 cm in 46 cases, and more than 2 cm in 23 cases, and the accuracy rate of CNB pathology results was 75.0%（3/4）, 98.3%（58/59）, 97.8%（45/46）, and 91.3%（21/23）, respectively, which was the highest in 0.5-2.0 cm. The accuracy, sensibility, specificity, positive predictive value, negative predictive value, failure rate, and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21% (127/132), 95.76% (113/118), 100% (14/14), 1 (113/113), 0.74 (14/19), 4.24%(5/118), and 0 (0/14), respectively. ConclusionUltrasound-guided CNB has important value on differential diagnosis of thyroid nodules, and important guiding significance on treatment of thyroid diseases.
Objective To further strengthen the understanding of the genesis of thyroid tumors through the analysis of thyroid nodules in the clonal origin. Method The related literatures which discussed the clonality of thyroid nodules were reviewed and analyzed. Results About the clonal origin of thyroid nodules， the X chromosome inactivation detection and single gene mutation detection were the most widely chosen one at present. Most of the materials available at present related to X chromosome inactivation proposed that major part of the thyroid nodules were monoclonal and the malignant cells spreaded by means of the inner lymphatic vessel net，whereas polyclonal and monoclonal thyroid nodules coexisted occasionally. Only BRAF mutation was found of certain importance in clonal origin identification in the thyroid nodules. Conclusions Thyroid nodule is prevalent in clinical practice，while the clonality of thyroid nodules especially the thyroid tumor is not clear. And for the time being the commonly used methods to identify the clonal origin of thyroid nodule are X chromosome inactivation and single gene mutation detection. Published results confirm the finding of X chromosome inactivation methods that the majority of thyroid nodules are monoclonally originated.
Objective To discuss the nursing measures for thyroid nodule patients who undergo core-needle biopsy (CNB) guided by ultrasound. Methods We retrospectively analyzed the experiences and main points of nursing for 1 900 thyroid nodule patients who underwent CNB guided by ultrasound between June 2010 and May 2014. Results All the 1 900 patients underwent CNB successfully. The nursing time was between 5 and 15 minutes, averaging (8.0±3.7) minutes. Complications included hematoma in 25 patients (1.3%) and needle syncope reaction in 30 patients (1.6%), which were cured through symptomatic treatment. No complications such as nerve injury, anesthesia accident or death occurred. No medical disputes happened due to specimen errors or loss. The success rate of specimen collection was 98.4% (1 870/1 900), and the diagnostic accuracy was 95.3% (1 812/1 900). Conclusions Ultrasonography-guided CNB is a safe and reliable operation with a high success rate, high diagnosis accuracy and few complications. Being familiar with the process of nursing cooperation and correct disposal and transfer of biopsy specimens are crucial for successful CNB in patients with thyroid nodules.
Objective To evaluate the clinical value of elasticity indicators in differential diagnosis of thyroid nodules. Methods Gray-scale ultrasound and elasticity imaging were used to examine 116 thyroid nodules. The rate of diameter change and ratio of area in the elasticity and gray-scale imaging were calculated and compared with pathology. Results In nodules of the ultrasonic elasticity grade 4 level and above, the proportion of malignant nodules was significanty higher than that of benign thyroid nodules （P＜0.05）. The malignant nodules was significanty higher than benign thyroid nodules in the rate of diameter change and ratio of area in the elasticity and gray-scale imaging （P＜0.05）. According to ROC analysis, the value of diagnosis and the diagnostic accuracy of the ratio of area was superior to that of the rate of diameter change （P＜0.05）. Conclusion As diagnostic indicators for differential diagnosis of thyroid nodules, the rate of diameter change and the ratio of area in elasticity can significantly improve the value of diagnosis and the accuracy of differential diagnosis level of thyroid nodules.