Objective:To investigate the value of coarse calcification ultrasound feature for the differential diagnosis of benign and malignant thyroid nodules and the China Thyroid Imaging Reporting and Data System (C-TIRADS) classification.Methods:A retrospective case series study was conducted. Two hundred and twenty solid thyroid nodules with coarse calcification confirmed by surgical pathology in 210 patients from January 2023 to February 2024 in Shanxi Province Cancer Hospital were selected. Using the postoperative pathological results as the gold standard, the nodules were divided into benign and malignant groups, and the ultrasound characteristics and specific features of coarse calcification of the nodules were compared between the two groups. Binary logistic regression analysis was used to screen for independent predictors of nodal malignancy in the coarse calcification features, and the independent predictors were assigned scores based on the C-TIRADS classification. The efficacy of C-TIRADS classification combined with independent predictors of nodal malignancy in the coarse calcification features for diagnosing malignant nodules was analyzed using receiver operating characteristic (ROC) curve.Results:The postoperative pathological findings of 220 thyroid nodules showed 70 (31.82%) were benign and 150 (68.18%) were malignant. The echogenicity, maximum diameter, orientation, margins of nodules and the location, number, promiscuity, peripheral soft tissue shadow of coarse calcification were compared between the benign and malignant groups, and the differences were statistically significant (all P < 0.05). Logistic regression analysis showed that the presence of coarse and irregular calcification ( OR = 7.20, 95% CI: 3.16-16.37, P < 0.001) and coarse calcification with peripheral soft tissue shadow ( OR = 7.87, 95% CI: 3.74-16.57, P < 0.001) were independent predictors for nodule malignancy. The area under the curve (AUC), sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification were 0.75, 66.67%, 81.43%, and 71.36%, respectively; the AUC, sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification combined with coarse and irregular calcification and peripheral soft tissue shadow were 0.88, 84.00%, 80.00%, and 82.73%, respectively; the difference in AUC for diagnosing malignant nodules with C-TIRADS classification alone and in combination with coarse calcification features was statistically significant ( Z = 4.69, P < 0.001). Conclusions:Coarse and irregular calcification and peripheral soft tissue shadow are risk factors for malignancy of thyroid nodules, and the diagnostic accuracy of the two in combination with C-TIRADS classification is high.

Objective:To explore the diagnostic value of quantitative analysis of contrast-enhanced ultrasound for the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) thyroid nodules 4.Methods:A retrospective case series study was conducted. A total of 87 patients with thyroid nodules from Shanxi Province Cancer Hospital between October 2018 and July 2022 were selected. All patients were diagnosed as C-TIRADS 4 thyroid nodules by routine ultrasound and had DICOM storage format ultrasound contrast dynamic data. All 96 thyroid nodules in 87 patients had clear surgical and pathological results. Based on the contrast-enhanced ultrasound features of the nodules, the nodules were reclassified by using C-TIRADS according to 3 different criteria. VueBox analysis software was used to obtain dynamic contrast-enhanced ultrasound (DCE-US) quantitative parameters, the most effective quantitative parameters for diagnosing thyroid malignant nodules were obtained by using receiver operating characteristic (ROC) curves, and their optimal cut-off values were obtained. Based on ultrasound contrast and DCE-US quantitative parameters, the nodules were reclassified by using C-TIRADS. Based on pathological results, the malignancy rates of nodules classified by C-TIRADS based on the conventional ultrasound, contrast-enhanced ultrasound, and contrast-enhanced ultrasound combined with DCE-US quantitative parameters were calculated. ROC curves were drawn to compare the diagnostic efficacy of conventional ultrasound, contrast-enhanced ultrasound, and contrast-enhanced ultrasound combined with DCE-US quantitative parameters for thyroid malignant nodules.Results:Among the 96 thyroid nodules, the malignancy rates of C-TIRADS 4a, 4b, and 4c nodules evaluated by conventional ultrasound were 50.0% (17/34), 72.1% (31/43) and 100.0% (19/19), respectively, which were not within the reference range provided by the C-TIRADS guideline. After reclassifying the nodules according to the contrast-enhanced ultrasound standards, the malignancy rates of C-TIRADS 3, 4a, 4b, 4c, 5 of nodules were 0 (0/2), 25.0% (2/8), 31.3% (5/16), 71.9% (23/32), and 97.4% (37/38), respectively. Among them, the malignancy rate of the 4a type nodule was still relatively high, which was not within the reference range given by the C-TIRADS guideline. The area under the curve of DCE-US quantitative parameter peak intensity (PE) for diagnosing thyroid malignant nodules according to ROC curves was the largest with the optimal cut-off value of 2080.7a.u. Based on contrast-enhanced ultrasound and combined with PE, the nodules were classified again, and the malignancy rates of C-TIRADS 3, 4a, 4b, 4c, 5 of nodules were 0 (0/7), 9.1% (1/11), 27.3% (3/11), 83.3% (11/13), and 98.1% (53/54), respectively, all were within the reference range provided by the C-TIRADS guideline. ROC curve analysis showed that the AUC of contrast-enhanced ultrasound combined with DCE-US quantitative parameter PE for diagnosing thyroid malignant nodules was greater than that of conventional ultrasound and contrast-enhanced ultrasound (both P < 0.05); the optimal cut-off value was type 4b, with the sensitivity of 94.0%, the specificity of 89.7%, and the accuracy of 92.7%. Conclusions:The combination of contrast-enhanced ultrasound and DCE-US quantitative parameter PE is helpful for more accurate classification of C-TIRADS 4 thyroid nodules and improves the diagnostic efficiency of thyroid malignant nodules.

Objective:To explore the diagnostic value of gradient characteristics of quantitative parameters of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinoma.Methods:A retrospective case series study was conducted. The clinical data of 120 patients with thyroid diseases who underwent pathological examination for samples collected through fine needle aspiration or surgical resection and underwent CEUS examination before surgery at Shanxi Province Cancer Hospital from January 2018 to May 2023 were collected. A total of 120 thyroid nodules were selected and divided into the benign group (37 nodules) and the malignant group (83 nodules) according to pathological results. The VueBox software was used to depict the four regions of interest in nodules of the two groups, which were the overall, central and marginal areas and surrounding normal thyroid tissues. The time-intensity curve (TIC) was drawn and the relevant parameters including peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-out rate (WoR), and time to increase (TI) were analyzed, and the gradient values (ΔPE within the nodules, ΔWiAUC within the nodules, ΔWiR within the nodules, ΔWoR within the nodules, ΔTI within the nodules) between two groups of nodules and surrounding normal tissues, as well as between the central and marginal areas of the nodules were calculated.Results:The conventional ultrasound characteristics of benign and malignant nodules showed only a statistically significant difference in aspect ratio ( χ2 = 14.76, P < 0.001). There were statistically significant differences in PE, WiAUC, WiR, and WoR between the overall malignant nodules and the surrounding normal tissues, as well as between the central and marginal areas within the nodules (all P < 0.05); there was a statistically significant difference in WiAUC between the overall benign nodules and the surrounding normal tissues (7 362.06 vs. 7 281.16, Z = -2.07, P = 0.038); there was no statistically significant difference in TI between the two groups of overall nodules and the surrounding normal tissues, as well as the central and marginal areas within the nodules (both P > 0.05); there were statistically significant differences in ΔPE, ΔWiAUC, ΔWiR, and ΔWoR in different regions of the nodules between the two groups (all P < 0.05); binary logistic analysis showed that overall ΔPE and intra nodule ΔWoR were independent predictive factors for the malignancy of thyroid nodules (both P < 0.05); receiver operating characteristic (ROC) curve analysis showed that the overall ΔPE had better diagnostic efficacy for benign and malignant thyroid nodules than the intra nodule ΔWoR, with a cut-off value of -536.23 a.u. Its combination with CEUS had the highest diagnostic efficacy for malignant thyroid nodules, with sensitivity, specificity, positive predictive value, and negative predictive value of 86.7%, 81.1%, 91.1%, and 73.2%, respectively. Conclusions:The peak intensity gradient value (overall ΔPE) between thyroid nodules and surrounding normal tissues can serve as an effective indicator for distinguishing between benign and malignant thyroid nodules. The combination of overall ΔPE and CEUS has good diagnostic efficacy.

Objective:To explore the diagnostic value of gradient characteristics of quantitative parameters of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinoma.Methods:A retrospective case series study was conducted. The clinical data of 120 patients with thyroid diseases who underwent pathological examination for samples collected through fine needle aspiration or surgical resection and underwent CEUS examination before surgery at Shanxi Province Cancer Hospital from January 2018 to May 2023 were collected. A total of 120 thyroid nodules were selected and divided into the benign group (37 nodules) and the malignant group (83 nodules) according to pathological results. The VueBox software was used to depict the four regions of interest in nodules of the two groups, which were the overall, central and marginal areas and surrounding normal thyroid tissues. The time-intensity curve (TIC) was drawn and the relevant parameters including peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-out rate (WoR), and time to increase (TI) were analyzed, and the gradient values (ΔPE within the nodules, ΔWiAUC within the nodules, ΔWiR within the nodules, ΔWoR within the nodules, ΔTI within the nodules) between two groups of nodules and surrounding normal tissues, as well as between the central and marginal areas of the nodules were calculated.Results:The conventional ultrasound characteristics of benign and malignant nodules showed only a statistically significant difference in aspect ratio ( χ2 = 14.76, P < 0.001). There were statistically significant differences in PE, WiAUC, WiR, and WoR between the overall malignant nodules and the surrounding normal tissues, as well as between the central and marginal areas within the nodules (all P < 0.05); there was a statistically significant difference in WiAUC between the overall benign nodules and the surrounding normal tissues (7 362.06 vs. 7 281.16, Z = -2.07, P = 0.038); there was no statistically significant difference in TI between the two groups of overall nodules and the surrounding normal tissues, as well as the central and marginal areas within the nodules (both P > 0.05); there were statistically significant differences in ΔPE, ΔWiAUC, ΔWiR, and ΔWoR in different regions of the nodules between the two groups (all P < 0.05); binary logistic analysis showed that overall ΔPE and intra nodule ΔWoR were independent predictive factors for the malignancy of thyroid nodules (both P < 0.05); receiver operating characteristic (ROC) curve analysis showed that the overall ΔPE had better diagnostic efficacy for benign and malignant thyroid nodules than the intra nodule ΔWoR, with a cut-off value of -536.23 a.u. Its combination with CEUS had the highest diagnostic efficacy for malignant thyroid nodules, with sensitivity, specificity, positive predictive value, and negative predictive value of 86.7%, 81.1%, 91.1%, and 73.2%, respectively. Conclusions:The peak intensity gradient value (overall ΔPE) between thyroid nodules and surrounding normal tissues can serve as an effective indicator for distinguishing between benign and malignant thyroid nodules. The combination of overall ΔPE and CEUS has good diagnostic efficacy.

Objective:To investigate the value of coarse calcification ultrasound feature for the differential diagnosis of benign and malignant thyroid nodules and the China Thyroid Imaging Reporting and Data System (C-TIRADS) classification.Methods:A retrospective case series study was conducted. Two hundred and twenty solid thyroid nodules with coarse calcification confirmed by surgical pathology in 210 patients from January 2023 to February 2024 in Shanxi Province Cancer Hospital were selected. Using the postoperative pathological results as the gold standard, the nodules were divided into benign and malignant groups, and the ultrasound characteristics and specific features of coarse calcification of the nodules were compared between the two groups. Binary logistic regression analysis was used to screen for independent predictors of nodal malignancy in the coarse calcification features, and the independent predictors were assigned scores based on the C-TIRADS classification. The efficacy of C-TIRADS classification combined with independent predictors of nodal malignancy in the coarse calcification features for diagnosing malignant nodules was analyzed using receiver operating characteristic (ROC) curve.Results:The postoperative pathological findings of 220 thyroid nodules showed 70 (31.82%) were benign and 150 (68.18%) were malignant. The echogenicity, maximum diameter, orientation, margins of nodules and the location, number, promiscuity, peripheral soft tissue shadow of coarse calcification were compared between the benign and malignant groups, and the differences were statistically significant (all P < 0.05). Logistic regression analysis showed that the presence of coarse and irregular calcification ( OR = 7.20, 95% CI: 3.16-16.37, P < 0.001) and coarse calcification with peripheral soft tissue shadow ( OR = 7.87, 95% CI: 3.74-16.57, P < 0.001) were independent predictors for nodule malignancy. The area under the curve (AUC), sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification were 0.75, 66.67%, 81.43%, and 71.36%, respectively; the AUC, sensitivity, specificity, and accuracy for diagnosing malignant nodules by C-TIRADS classification combined with coarse and irregular calcification and peripheral soft tissue shadow were 0.88, 84.00%, 80.00%, and 82.73%, respectively; the difference in AUC for diagnosing malignant nodules with C-TIRADS classification alone and in combination with coarse calcification features was statistically significant ( Z = 4.69, P < 0.001). Conclusions:Coarse and irregular calcification and peripheral soft tissue shadow are risk factors for malignancy of thyroid nodules, and the diagnostic accuracy of the two in combination with C-TIRADS classification is high.

Objective:To explore the diagnostic value of quantitative analysis of contrast-enhanced ultrasound for the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) thyroid nodules 4.Methods:A retrospective case series study was conducted. A total of 87 patients with thyroid nodules from Shanxi Province Cancer Hospital between October 2018 and July 2022 were selected. All patients were diagnosed as C-TIRADS 4 thyroid nodules by routine ultrasound and had DICOM storage format ultrasound contrast dynamic data. All 96 thyroid nodules in 87 patients had clear surgical and pathological results. Based on the contrast-enhanced ultrasound features of the nodules, the nodules were reclassified by using C-TIRADS according to 3 different criteria. VueBox analysis software was used to obtain dynamic contrast-enhanced ultrasound (DCE-US) quantitative parameters, the most effective quantitative parameters for diagnosing thyroid malignant nodules were obtained by using receiver operating characteristic (ROC) curves, and their optimal cut-off values were obtained. Based on ultrasound contrast and DCE-US quantitative parameters, the nodules were reclassified by using C-TIRADS. Based on pathological results, the malignancy rates of nodules classified by C-TIRADS based on the conventional ultrasound, contrast-enhanced ultrasound, and contrast-enhanced ultrasound combined with DCE-US quantitative parameters were calculated. ROC curves were drawn to compare the diagnostic efficacy of conventional ultrasound, contrast-enhanced ultrasound, and contrast-enhanced ultrasound combined with DCE-US quantitative parameters for thyroid malignant nodules.Results:Among the 96 thyroid nodules, the malignancy rates of C-TIRADS 4a, 4b, and 4c nodules evaluated by conventional ultrasound were 50.0% (17/34), 72.1% (31/43) and 100.0% (19/19), respectively, which were not within the reference range provided by the C-TIRADS guideline. After reclassifying the nodules according to the contrast-enhanced ultrasound standards, the malignancy rates of C-TIRADS 3, 4a, 4b, 4c, 5 of nodules were 0 (0/2), 25.0% (2/8), 31.3% (5/16), 71.9% (23/32), and 97.4% (37/38), respectively. Among them, the malignancy rate of the 4a type nodule was still relatively high, which was not within the reference range given by the C-TIRADS guideline. The area under the curve of DCE-US quantitative parameter peak intensity (PE) for diagnosing thyroid malignant nodules according to ROC curves was the largest with the optimal cut-off value of 2080.7a.u. Based on contrast-enhanced ultrasound and combined with PE, the nodules were classified again, and the malignancy rates of C-TIRADS 3, 4a, 4b, 4c, 5 of nodules were 0 (0/7), 9.1% (1/11), 27.3% (3/11), 83.3% (11/13), and 98.1% (53/54), respectively, all were within the reference range provided by the C-TIRADS guideline. ROC curve analysis showed that the AUC of contrast-enhanced ultrasound combined with DCE-US quantitative parameter PE for diagnosing thyroid malignant nodules was greater than that of conventional ultrasound and contrast-enhanced ultrasound (both P < 0.05); the optimal cut-off value was type 4b, with the sensitivity of 94.0%, the specificity of 89.7%, and the accuracy of 92.7%. Conclusions:The combination of contrast-enhanced ultrasound and DCE-US quantitative parameter PE is helpful for more accurate classification of C-TIRADS 4 thyroid nodules and improves the diagnostic efficiency of thyroid malignant nodules.

Objective:To investigate the ultrasound image and pathological features of invasive fibromatosis, and to provide a basis for the diagnosis of invasive fibromatosis.Methods:The clinicopathological data of 22 patients pathologically diagnosed with invasive fibromatosis from January 2016 to March 2019 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The clinical, ultrasound and pathological data were also summarized.Results:Ultrasound images of invasive fibromatosis showed irregular morphology, unclear boundaries, uneven echo, spot-like or strip-shaped blood flow signals. The coincidence rate of ultrasound diagnosis was 59.1% (13/22), 3 cases were misdiagnosed as fibrous, fat and other sarcomas, 4 cases were misdiagnosed as nerve-derived tumors, 1 case was misdiagnosed as nodular fasciitis, and 1 case was misdiagnosed as gastrointestinal stromal tumor. The pathological characteristics of invasive fibromatosis were more typical, and the positive expression rate of vimentin and β-catenin in immunohistochemistry was 100.0% (22/22); the coincidence rate of preoperative pathological diagnosis of puncture was 78.6% (11/14), 1 case was misdiagnosed as nerve fiber tumor, 1 case was misdiagnosed as low-grade fibromyxoid sarcoma, and 1 case was misdiagnosed as nodular fasciitis.Conclusion:Invasive fibromatosis has a certain specificity in ultrasound and pathological diagnosis, which can be diagnosed and differentially diagnosed according to the ultrasound image and pathological characteristics.

Objective:To investigate the relationship between BRAF V600E gene mutation and ultrasonography manifestations as well as the lesion invasiveness in thyroid cancer.Methods:A total of 153 patients pathologically diagnosed as thyroid cancer after surgery who underwent thyroidectomy in Shanxi Provincial Cancer Hospital from January 2018 to October 2019 were selected, including 146 cases of papillary thyroid carcinoma. Ultrasonography was performed before operation. Paraffin embedded tissue after operation was used to detect BRAF V600E gene mutation. According to the results of BRAF V600E gene detection, patients were divided into mutation group and non-mutation group. The ultrasonic characteristics of the two groups were compared. The relationship of BRAF V600E gene mutation with ultrasonic characteristics, clinicopathological characteristics as well as cervical lymph node metastasis was analyzed by using logistic regression.Results:There were 130 cases (85.0%) of BRAF V600E gene mutation and 23 cases of BRAF V600E gene non-mutation in 153 patients with thyroid cancer. Among 146 cases with papillary thyroid carcinoma, there were 128 cases (87.7%) of BRAF V600E gene mutation. The percentage of patients with the unclear boundary between thyroid lesions and capsule in BRAF V600E gene mutation group was higher than that of patients in non-mutation group, and the difference was statistically significant [46.9% (60/128) vs. 11.1% (2/18), χ 2 = 8.261, P = 0.004]. There were no significant differences in age, gender, nodule long diameter, aspect ratio, nodal location, internal calcification, internal echo, echo uniformity, cystic solid, nodal shape, boundary clarity, blood flow signal, the number of tumor site, lymph node metastasis and nodular goiter between BRAF gene mutation group and non-mutation group (all P > 0.05). The results of logistic regression analysis showed that only the boundary clarity between thyroid lesions and capsule was an independent influencing factor of BRAF V600E gene mutation ( OR = 14.400, 95% CI 1.847-112.246, P = 0.011), tumor lesion size was an independent influencing factor of cervical lymph node metastasis in papillary thyroid carcinoma ( OR = 2.714, 95% CI 1.335-5.517, P = 0.006). Conclusions:In papillary thyroid carcinoma, BRAF V600E gene mutation is related with lesion and the unclear boundary between the tumor and capsule, but not related with lymph node metastasis. The size of the tumor lesion is associated with lymph node metastasis.

Objective: To investigate the location, size, ultrasonic characteristics and clinical significances of normal parathyroid glands. Methods: A total of 350 healthy subjects with no relevant diseases in Shanxi Provincial Cancer Hospital from January 2017 to December 2017 were selected. The age ranged from 9 to 83 years old. They were divided into seven groups according to age, with 50 in each group. The position, size, shape, echo, boundary, and blood flow signal characteristics of the normal parathyroid glands in these healthy subjects examined by ultrasound were retrospectively analyzed, and the differences among the different groups were compared. Results: The detection rate of normal parathyroid glands in 350 subjects was 95.4% (1 335/1 400). The normal parathyroid glands were oval, fusiform or irregular shape hyperechoic or isoechoic nodules, with homogeneous echoes and clear borders. There was no obvious blood flow signal in most glands. The proportion of fusiform shape in upper parathyroid glands (24.4%, 161/659) was higher than that in lower parathyroid glands (18.4%, 125/676), the difference was statistically significant (χ ² = 6.99, P < 0.05). The superior parathyroid gland was mainly located in the superior thyroid region, while the inferior parathyroid gland was mainly located in the inferior thyroid region, especially within the range of 2 cm from the inferior thyroid pole. In the age ≤ 20 years old group, the proportion of patients with upper parathyroid gland in the upper thyroid region (80.4%, 74/92) was higher than that in the other age groups, and the proportion of patients with lower parathyroid gland in the subthyroid region (30.6%, 30/98) was higher than that in the other age groups, the difference was statistically significant (χ ² = 3.35, P < 0.05). There was no significant difference in the size of parathyroid gland among different age groups (P > 0.05). Conclusions The detection rate of normal parathyroid glands is high, and they mainly located in the upper and lower thyroid regions within 2 cm from the lower margin of the thyroid. Ultrasound images are mainly characterized by the clear elliptical shape and the uniform high echo. The ultrasonic characteristics of normal parathyroid glands are conducive to preoperative localization of parathyroid glands and provides a reliable basis for finding and retaining parathyroid glands in thyroid surgery.

Objective: To evaluate the usage of ultrasound guided wire-localization, nano-carbon staining and the combination of the above two methods in detecting sentinel lymph node (SLN) in breast cancer. Methods: A total of 159 cases of breast cancer from May 2015 to December 2017 in Shanxi Provincial Cancer Hospital were selected, and they were treated with ultrasound guided wire-localization, nano-carbon staining and combination of the two methods separately to detect SLN before the operation. After the operation, SLN and axillary lymph node in each group were marked and made pathological diagnosis. Results: There were 69 cases with pathological diagnosis of SLN metastasis and 90 cases without abnormal representation. With the patient as the unit, the sensitivity of ultrasound guided wire-localization was 100.0% (69/69), the sensitivity of nano-carbon staining was 98.6% (68/69), and the sensitivity of combination of the two methods was 97.1% (67/69). The specificity of ultrasound guided wire-localization was 3.3% (3/90), the specificity of nano-carbon staining was 2.2% (2/90), and the specificity of combination of the two methods was 5.6% (5/90). With the count of SLN as the unit, the combination of the two methods had the highest diagnostic efficiency in detecting SLN, and the difference was statistical significant (χ² = 34.31, P < 0.001). Conclusions Ultrasound guided wire-localization and nano-carbon staining are safe and accessible methods for detecting SLN. It provides a precise treatment for early breast cancer, and it can protect medical staff from radiation, which is expected to be the best method for detection of SLN in breast cancer.