Analysis of the ultrasonographic and pathological characteristics of benign thyroidnodules in thyroid imaging reporting and data system 4 class_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KONG Fanping ¹ , WU Yiyun ² ,  CAO Shibing ¹

1. Department of General Surgery, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, P. R. China;
2. Department of Ultrasound, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, P. R. China;

Corresponding?author：

CAO Shibing, Email: doc99cao@126.com

Keywords：

benign thyroid nodule; thyroid imaging reporting and data system 4 class; ultrasound; pathological examination

DOI：

10.7507/1007-9424.201710016

Video：

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Objective To summarize the ultrasonographic and pathological features of benign thyroid nodules in thyroid imaging reporting and data system (TI-RADS) 4 class. Methods The preoperative ultrasonographic features and pathological features of 46 patients (52 nodules) with TI-RADS 4 class benign thyroid nodules who got treatment in Affiliated Hospital of Nanjing University of Traditional Chinese Medicine between June 2016 and June 2017 were retrospectively analyzed. Results Among the 52 thyroid nodules, 32 nodules (61.54%) were categorized as TI-RADS 4A, 12 nodules (23.08%) were categorized as TI-RADS 4B, and 8 nodules (15.38%) were categorized as TI-RADS 4C. On ultrasonographic images, the 52 thyroid nodules showed hypoechogenicity (90.38%), solid or predominantly solid (98.08%), nodules>1 cm in diameter (61.54%), defined margin (63.46%), microcalcification (50.00%), abundant or pointy blood flow (65.39%), morphological rule (90.38%), aspect ratio≤1 (92.31%), and no suspicious lymph nodes (86.54%). On histology, these thyroid nodules revealed nodular goiter with fibrosis or calcification (38.46%), nodular goiter with adenoma (30.77%), nodular goiter (9.61%), Hashimoto’s thyroiditis (17.31%), and thyroid follicular adenoma (3.85%). Conclusion Nodular goiter (thyroid nodules with fibrosis, calcification or adenomatoid hyperplasia), Hashimoto’s thyroiditis, and thyroid follicular adenoma will lead to malignant signs on ultrasonographic images, we should refer to other examination methods to make combinated evaluation.

Citation： KONG Fanping, WU Yiyun, CAO Shibing. Analysis of the ultrasonographic and pathological characteristics of benign thyroidnodules in thyroid imaging reporting and data system 4 class. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 559-564. doi: 10.7507/1007-9424.201710016 Copy

1.	Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology, 2011, 260(3): 892-899.
2.	張微微, 龍春艷, 林少建. TI-RADS分類及超聲多普勒血流信號在分化型甲狀腺癌中的應用價值. 中國醫藥科學, 2016, 6(19): 18-22.
3.	Chen SJ, Yu SN, Tzeng JE, et al. Characterization of the major histopathological components of thyroid nodules using sonographic textural features for clinical diagnosis and management. Ultrasound Med Biol, 2009, 35(2): 201-208.
4.	Ha EJ, Baek JH, Lee JH, et al. Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid, 2013, 23(6): 703-708.
5.	Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology, 2008, 247(3): 762-770.
6.	盧瓊潔, 何學森, 許麗萍, 等. 超聲對甲狀腺癌的漏誤診原因分析. 山西醫藥雜志, 2015, 44(10): 1104-1106.
7.	Su JJ, Hui LZ, Xi CJ, et al. Correlation analysis of ultrasonic characteristics, pathological type, and molecular markers of thyroid nodules. Genet Mol Res, 2015, 14(1): 9-20.
8.	Na DG, Baek JH, Sung JY, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid, 2016, 26(4): 562-572.
9.	張波, 徐景竹, 吳瓊. 2015年美國甲狀腺學會《成人甲狀腺結節與分化型甲狀腺癌診治指南》解讀: 超聲部分. 中國癌癥雜志, 2016, 26(1): 19-24.
10.	周潯丹, 楊利霞, 甄艷華. 結合UE的TI-RADS分級在甲狀腺結節定性診斷價值的探討. 延安大學學報(醫學科學版), 2011, 9(4): 19-21.
11.	鄭麗萍, 徐晚虹, 呂國榮, 等. 優化TI-RADS分類鑒別診斷甲狀腺良惡性結節. 中國醫學影像技術, 2016, 32(11): 1668-1672.
12.	牛衛東, 趙誠, 臧翊辰, 等. 甲狀腺濾泡癌和濾泡性腺瘤的超聲診斷與鑒別價值. 中華臨床醫師雜志(電子版), 2015, 9(22): 4105-4109.
13.	代妮娜, 劉超, 張文君. 超聲對濾泡型甲狀腺乳頭狀癌和濾泡性腺瘤的鑒別診斷價值. 安徽醫藥, 2016, 20(6): 1103-1107.
14.	姚向平. 超聲聯合CT檢查對甲狀腺濾泡性病變的診斷價值. 現代實用醫學, 2016, 28(4): 468-469.
15.	其阿米西·別孜爾見, 哈力木拉提·木爾提扎, 哈爾滿·阿吉漢, 等. 術前血清TSH水平與甲狀腺微小乳頭狀癌發生的相關性研究. 中國普外基礎與臨床雜志, 2017, 24(1): 64-69.
16.	黃嫻, 徐輝雄, 張一峰, 等. 血清促甲狀腺激素在甲狀腺TI-RADS 4類結節良惡性鑒別中的價值分析. 臨床超聲醫學雜志, 2017, 19(4): 286-287.
17.	Shao J, Shen Y, Lü J, et al. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol (Oxf), 2015, 83(2): 254-260.
18.	王琰, 崔可飛, 馬笑. 超聲造影評分對甲狀腺TI-RADS 4類結節良惡性的診斷價值. 中國超聲醫學雜志, 2015, 31(10): 880-883.
19.	馬慧娟, 楊敬春, 冷振鵬, 等. 超聲造影聯合彈性成像對甲狀腺影像報告和數據系統4類甲狀腺結節的診斷價值. 中華醫學超聲雜志(電子版), 2016, 13(12): 911-917.
20.	Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab, 2009, 94(5): 1748-1751.
21.	Horvath E, Silva CF, Majlis S, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol, 2017, 27(6): 2619-2628.
22.	盧捷, 張曉林. 超聲引導下甲狀腺細針穿刺細胞學在甲狀腺超聲影像報告和數據系統4a級結節中的應用價值. 中國藥物與臨床, 2017, 17(5): 664-666.
23.	楊海兵, 朱慶, 楊光倫. 甲狀腺癌分子診斷及治療進展. 中國普外基礎與臨床雜志, 2016, 23(1): 109-113.
24.	Nacamulli D, Nico L, Barollo S, et al. Comparison of the diagnostic accuracy of combined elastosonography and BRAF analysis vs cytology and ultrasonography for thyroid nodule suspected of malignancy. Clin Endocrinol (Oxf), 2012, 77(4): 608-614.
25.	De Napoli L, Bakkar S, Ambrosini CE, et al. Indeterminate Single Thyroid Nodule: Synergistic Impact of Mutational Markers and Sonographic Features in Triaging Patients to Appropriate Surgery. Thyroid, 2016, 26(3): 390-394.
26.	Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet, 2013, 381(9871): 1058-1069.
27.	Nikiforov YE, Ohori NP, Hodak SP, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab, 2011, 96(11): 3390-3397.

1. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology, 2011, 260(3): 892-899.
2. 張微微, 龍春艷, 林少建. TI-RADS分類及超聲多普勒血流信號在分化型甲狀腺癌中的應用價值. 中國醫藥科學, 2016, 6(19): 18-22.
3. Chen SJ, Yu SN, Tzeng JE, et al. Characterization of the major histopathological components of thyroid nodules using sonographic textural features for clinical diagnosis and management. Ultrasound Med Biol, 2009, 35(2): 201-208.
4. Ha EJ, Baek JH, Lee JH, et al. Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid, 2013, 23(6): 703-708.
5. Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology, 2008, 247(3): 762-770.
6. 盧瓊潔, 何學森, 許麗萍, 等. 超聲對甲狀腺癌的漏誤診原因分析. 山西醫藥雜志, 2015, 44(10): 1104-1106.
7. Su JJ, Hui LZ, Xi CJ, et al. Correlation analysis of ultrasonic characteristics, pathological type, and molecular markers of thyroid nodules. Genet Mol Res, 2015, 14(1): 9-20.
8. Na DG, Baek JH, Sung JY, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid, 2016, 26(4): 562-572.
9. 張波, 徐景竹, 吳瓊. 2015年美國甲狀腺學會《成人甲狀腺結節與分化型甲狀腺癌診治指南》解讀: 超聲部分. 中國癌癥雜志, 2016, 26(1): 19-24.
10. 周潯丹, 楊利霞, 甄艷華. 結合UE的TI-RADS分級在甲狀腺結節定性診斷價值的探討. 延安大學學報(醫學科學版), 2011, 9(4): 19-21.
11. 鄭麗萍, 徐晚虹, 呂國榮, 等. 優化TI-RADS分類鑒別診斷甲狀腺良惡性結節. 中國醫學影像技術, 2016, 32(11): 1668-1672.
12. 牛衛東, 趙誠, 臧翊辰, 等. 甲狀腺濾泡癌和濾泡性腺瘤的超聲診斷與鑒別價值. 中華臨床醫師雜志(電子版), 2015, 9(22): 4105-4109.
13. 代妮娜, 劉超, 張文君. 超聲對濾泡型甲狀腺乳頭狀癌和濾泡性腺瘤的鑒別診斷價值. 安徽醫藥, 2016, 20(6): 1103-1107.
14. 姚向平. 超聲聯合CT檢查對甲狀腺濾泡性病變的診斷價值. 現代實用醫學, 2016, 28(4): 468-469.
15. 其阿米西·別孜爾見, 哈力木拉提·木爾提扎, 哈爾滿·阿吉漢, 等. 術前血清TSH水平與甲狀腺微小乳頭狀癌發生的相關性研究. 中國普外基礎與臨床雜志, 2017, 24(1): 64-69.
16. 黃嫻, 徐輝雄, 張一峰, 等. 血清促甲狀腺激素在甲狀腺TI-RADS 4類結節良惡性鑒別中的價值分析. 臨床超聲醫學雜志, 2017, 19(4): 286-287.
17. Shao J, Shen Y, Lü J, et al. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol (Oxf), 2015, 83(2): 254-260.
18. 王琰, 崔可飛, 馬笑. 超聲造影評分對甲狀腺TI-RADS 4類結節良惡性的診斷價值. 中國超聲醫學雜志, 2015, 31(10): 880-883.
19. 馬慧娟, 楊敬春, 冷振鵬, 等. 超聲造影聯合彈性成像對甲狀腺影像報告和數據系統4類甲狀腺結節的診斷價值. 中華醫學超聲雜志(電子版), 2016, 13(12): 911-917.
20. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab, 2009, 94(5): 1748-1751.
21. Horvath E, Silva CF, Majlis S, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol, 2017, 27(6): 2619-2628.
22. 盧捷, 張曉林. 超聲引導下甲狀腺細針穿刺細胞學在甲狀腺超聲影像報告和數據系統4a級結節中的應用價值. 中國藥物與臨床, 2017, 17(5): 664-666.
23. 楊海兵, 朱慶, 楊光倫. 甲狀腺癌分子診斷及治療進展. 中國普外基礎與臨床雜志, 2016, 23(1): 109-113.
24. Nacamulli D, Nico L, Barollo S, et al. Comparison of the diagnostic accuracy of combined elastosonography and BRAF analysis vs cytology and ultrasonography for thyroid nodule suspected of malignancy. Clin Endocrinol (Oxf), 2012, 77(4): 608-614.
25. De Napoli L, Bakkar S, Ambrosini CE, et al. Indeterminate Single Thyroid Nodule: Synergistic Impact of Mutational Markers and Sonographic Features in Triaging Patients to Appropriate Surgery. Thyroid, 2016, 26(3): 390-394.
26. Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet, 2013, 381(9871): 1058-1069.
27. Nikiforov YE, Ohori NP, Hodak SP, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab, 2011, 96(11): 3390-3397.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the ultrasonographic and pathological characteristics of benign thyroidnodules in thyroid imaging reporting and data system 4 class

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