A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers

Objective To investigate the value of ultrasound gray-scale ratio (UGSR) for the differential diagnosis of papillary thyroid microcarcinoma (PTMC) and micronodular goiter (MNG) in two medical centers. Methods Ultrasound images of 881 PTMCs from 785 patients and 744 MNGs from 687 patients in center A were retrospectively analyzed and compared with 243 PTMCs from 203 patients and 251 MNGs from 198 patients in center B. All cases were confirmed by surgery and histology. The grayscale values of thyroid lesions and surrounding normal tissues were measured, and the UGSR was calculated. The optimal UGSR threshold for identifying PTMCs and MNGs in two medical centers was determined by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared between the two medical centers. Results The UGSR values of PTMCs and MNGs in medical center A were 0.5537 (0.4699, 0.6515) and 0.8708 (0.7616, 1.0123) (Z = -27.691, P = 0), respectively, whereas those in medical center B were 0.5517 (0.4698, 0.6377) and 0.8539 (0.7366, 0.9929) (Z = -16.057, P = 0), respectively. The UGSR of PTMCs and MNGs did not differ significantly between the two medical centers (Z = -0.609, P = 0.543 and Z = -1.394, P = 0.163, respectively). The AUC, optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two medical centers were 0.898 vs. 0.918, 0.7214 vs. 0.6911, 0.881 vs. 0.868, 0.817 vs. 0.833, 0.851 vs. 0.834, 0.853 vs. 0.867, and 0.852 vs. 0.850, respectively. Conclusions UGSR can quantify the echo intensity of PTMCs and MNGs and is therefore valuable for the differential diagnosis of the two diseases. The diagnostic efficacy was consistent between the two medical centers. This method should be widely promoted and applied.

[1]  D. Luo,et al.  The clinical significance of ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules , 2018, Journal of cancer research and therapeutics.

[2]  Gilles Russ,et al.  European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS , 2017, European Thyroid Journal.

[3]  G. Grani,et al.  Grey-Scale Analysis Improves the Ultrasonographic Evaluation of Thyroid Nodules , 2015, Medicine.

[4]  Ga Ram Kim,et al.  Sonographic Characteristics Suggesting Papillary Thyroid Carcinoma According to Nodule Size , 2013, Annals of Surgical Oncology.

[5]  Jing Li,et al.  Re: "ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee". , 2018, Journal of the American College of Radiology : JACR.

[6]  R. Nayar,et al.  Subcentimeter thyroid nodules: utility of sonographic characterization and ultrasound-guided needle biopsy. , 2011, AJR. American journal of roentgenology.

[7]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[8]  William D Middleton,et al.  ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. , 2018, Journal of the American College of Radiology : JACR.

[9]  Jeong Hyun Lee,et al.  Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. , 2008, Radiology.

[10]  S. Zhang,et al.  The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules , 2019, Cancer medicine.

[11]  Ilenia Pirola,et al.  Thyroid nodule shape suggests malignancy. , 2006, European journal of endocrinology.

[12]  Wenping Wang,et al.  Diagnostic performances of various gray-scale, color Doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules. , 2014, Thyroid : official journal of the American Thyroid Association.

[13]  J. Baek,et al.  Detection of Malignancy Among Suspicious Thyroid Nodules <1 cm on Ultrasound with Various Thyroid Image Reporting and Data Systems. , 2017, Thyroid : official journal of the American Thyroid Association.

[14]  J. Kwak,et al.  Positive predictive values of sonographic features of solid thyroid nodule. , 2010, Clinical imaging.

[15]  B. Liu,et al.  A Taller‐Than‐Wide Shape Is a Good Predictor of Papillary Thyroid Carcinoma in Small Solid Nodules , 2015, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[16]  Huan Liu,et al.  Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis. , 2020, European journal of radiology.

[17]  Anna Crescenzi,et al.  Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. , 2002, The Journal of clinical endocrinology and metabolism.

[18]  Jinwang Ding,et al.  Differential diagnosis value of the ultrasound gray scale ratio for papillary thyroid microcarcinomas and micronodular goiters. , 2018, Quantitative imaging in medicine and surgery.

[19]  Dong Gyu Na,et al.  Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations , 2016, Korean journal of radiology.