AUTHOR=Wang Chen-Yi , Li Yang , Zhang Meng-Meng , Yu Zhi-Long , Wu Zi-Zhen , Li Chen , Zhang Dong-Chen , Ye Ying-Jiang , Wang Shan , Jiang Ke-Wei 

TITLE=Analysis of Differential Diagnosis of Benign and Malignant Partially Cystic Thyroid Nodules Based on Ultrasound Characterization With a TIRADS Grade-4a or Higher Nodules

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.861070

DOI=10.3389/fendo.2022.861070

ISSN=1664-2392

ABSTRACT=Partially cystic thyroid nodules (PCTNs) is a kind of thyroid nodule with both solid and cystic components, and are usually misdiagnosed as benign nodules. The objective of this study was to determine the ultrasound (US) characterizations with a TIRADS Grade-4a or higher partially cystic thyroid nodules (PCTNs) which are associated with malignancy or benign. 133 PCTNs with a TIRADS Grade-4a or higher were enrolled in this study, 83 were malignant and 50 were benign. TI-RADS classification can detect malignant PCTNs, and its sensitivity, specificity, positive predictive value, negative predictive value and accuracy are 39.8%, 96.0%, 94.3%, 49.0% and 60.9%, respectively. Univariate analyses revealed that nodule shape, margin, and structure were related to PCTNs' benign and malignant,among which nodule taller-than-wide, irregular shape, non-smooth margin, eccentric sharp angle, and edge sharp angle were significantly associated with malignancy while ovoid to round nodules, smooth margins, multiple separation, and eccentric obtuse angle structures were significantly associated with benign nature. For the solid part of PCTNs, its free margin, echo and calcification are related to benign and malignant PCTNs. Among them, the free margin of the solid part is non-smooth, hypoechoic, and microcalcification are related to malignant PCTNs, while the free margin of the solid part is smooth, isoechoic, macrocalcification, non-calcification are related to benign PCTNs. Calcification of solid part and free margin are important factors for predicting malignant PCTNs. In addition, nodules' composition, blood flow signal and other factors had nothing to do with PCTNs' benign or malignant. In the multivariate Logistic regression analysis, solid part calcification (OR: 17.28; 95%CI: 5.14~58.08) and free margin (OR: 3.18; 95%CI: 1.01~10.00) were revealed to be the strongest independent predictor for malignancy(P<0.05). Our study indicated that understanding the ultrasound characteristics of malignant PCTNs, to avoid misdiagnosed PCTNs patients, is important to make a precise diagnosis and prognosis of PCTNs.