摘要:目的:采用Meta分析的方法评价甲状腺球蛋白在甲状腺良性疾病和甲状腺癌中的临床意义。方法:通过检索MEDLINE、EMBASE、The Cochrane Library, 中国生物医学文献数据库、中国学术期刊全文数据库和其他方式广泛收集文献。根据QUADAS质量评价标准评价纳入文献的质量,用MetaDisc软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线(summary receiver operator characteristic curve,SROC)。结果:最终纳入5篇文献。合并敏感度0.60,合并特异度0.83,合并比值比2.68, SROC下面积(AUC)=0.645 4。结论:现有研究证实:甲状腺球蛋白在甲状腺癌中的阳性率是甲状腺良性疾病中的2.68倍,有统计学差异,但敏感度不高。尚需更多设计严谨、科学的临床试验进一步证实。Abstract: Objective: To evaluate the quality of the current studies involving the value of serum thyroglobulin in the diagnosis of thyroid benign diseases and thyroid carcinoma. Methods: We comprehensive collected current studies about serum thyroglobulin in thyroid benign diseases and thyroid carcinoma by computer and manual searches. QUADAS items were used for quality assessment in our systematic review. Metadisc software was used to analyze pooled sensitivity, pooled specificity,pooled positive likelihood ratio and pooled negative likelihood ratio,pooled diagnostic test odds ratio and heterogeneity test,and draw summary receiver operator characteristic curve (SROC). Results: Totally 5 studies were included. To identify thyroid benign diseases and thyroid carcinoma, pooled sensitivity was 0.60, pooled specificity was 0.83,pooled odds ratio was 2.68, the area under curve (AUC) was 0.645 4.Conclusion: The results of statistic alanalysis showed that the positive rate of thyroglobulin in thyroid carcinoma is 2.68 times more than in benign thyroid diseases. There was significant difference. But sensitivity was not high and reporting quality of the studies was relatively poor. The conclusion still need more clinical trials to confirm.
Ultrasound is the best way to diagnose thyroid nodules. To discriminate benign and malignant nodules, calcification is an important characteristic. However, calcification in ultrasonic images cannot be extracted accurately because of capsule wall and other internal tissue. In this paper, deep learning was first proposed to extract calcification, and two improved methods were proposed on the basis of Alexnet convolutional neural network. First, adding the corresponding anti-pooling (unpooling) and deconvolution layers (deconv2D) made the network to be trained for the required features and finally extract the calcification feature. Second, modifying the number of convolution templates and full connection layer nodes made feature extraction more refined. The final network was the combination of two improved methods above. To verify the method presented in this article, we got 8 416 images with calcification, and 10 844 without calcification. The result showed that the accuracy of the calcification extraction was 86% by using the improved Alexnet convolutional neural network. Compared with traditional methods, it has been improved greatly, which provides effective means for the identification of benign and malignant thyroid nodules.
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 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 evaluate the clinical value of ultrasonic elastosonography in the diagnosis of thyroid nodules. MethodsThe elastosonography images of 119 thyroid nodules in 71 patients treated between February 2010 and February 2013 were analyzed and the hardness of the nodule was classified into five grades according to the results of elastosonography. It was defined that the nodules with grade 0-Ⅱ hardness were benign while those with grade Ⅲ-Ⅳ were malignant. The results of elastosonography were compared with surgery and pathology. ResultsIn these patients, the number of benign and malignant thyroid nodules were 102 and 17, respectively according to pathology. The sensitivity, specificity and accuracy of elastosonography in the diagnosis of thyroid nodules were respectively 100.0%, 73.5% and 77.3%. ConclusionUltrasonic elastosonography is helpful in the diagnosis between benign and malignant thyroid nodules; the combined elastosonography and conventional ultrasound can improve diagnostic accuracy.
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 evaluate the diagnostic value of BRAFV600E mutation test in high-risk thyroid nodules with easily underdiagnosed fine-needle aspiration biopsy (FNAB) results.MethodsRetrospectively collected 122 cases of thyroid nodule who treated in the Hebei Petrochina Central Hospital between January 2017 and December 2018, all the cases admitted preoperative ultrasound and FNAB detection. All of the patients had the non-positive cytological results of FNAB and the high-risk features of ultrasound. Contrasted the postoperative pathological coincidence rate of combination of FNAB and BRAFV600E test with FNAB alone.ResultsThe BRAFV600E mutation rate was 27.0% (33/122). The positive rate of BRAFV600E mutation increased with the increase of ultrasound thyroid imaging reporting and data system(TI-RADS) grade (P<0.05), which was independent of patients’ age, gender, number of nodules, diameter of nodules, and FNAB results (P>0.05). The coincidence rate of FNAB combined with BRAFV600E mutation detection was higher than that of FNAB alone ［86.9% (106/122) vs. 69.7% (85/122), P<0.05).ConclusionsThe BRAFV600E mutation test can detect papillary thyroid carcinoma that might be missed by FNAB. We recommend that FNAB should be routinely accompanied by the BRAFV600E mutation test in the high-risk thyroid nodules.
ObjectiveThyroid nodules are an exceptionally common thyroid disorder. Past studies suggested a possible link between thyroid diseases and breast neoplasms. However, few studies have delved into the causal relationship between thyroid nodules and breast neoplasms. This study conducted a Mendelian randomization (MR) analysis to further investigate the causal relationship between them. MethodsThis study was conducted using data sourced from genome-wide association study (GWAS) summary datasets. The study focused on thyroid nodules, benign breast tumors, and malignant breast cancers as the research objects, and relevant single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs). The inverse-variance weighted (IVW) was primarily used to assess the causal relationship between thyroid nodules and breast neoplasms. Cochran’s Q test was employed to detect heterogeneity, while MR-Egger intercept and MR-PRESSO were used to test for pleiotropy. Sensitivity analysis was conducted using the leave-one-out method. ResultsThere was a significant causal relationship between thyroid nodules and malignant neoplasm of breast (OR=0.88, 95%CI 0.83 to 0.95, P<0.01), with no evidence of reverse causality between them (OR=1.01, 95%CI 0.99 to 1.03, P=0.16). No causal relationship was found between thyroid nodules and benign neoplasm of breast, as indicated by both forward MR analysis (OR=0.97, 95%CI 0.89 to 1.06, P=0.51) and reverse MR analysis (OR=0.97, 95%CI 0.92 to 1.04, P=0.40). Sensitivity analyses suggested that the study findings were accurate and reliable. ConclusionThe present study identifies thyroid nodules as a potential protective factor for malignant neoplasm of breast.