Diagnostic value of multimodal ultrasound in cytologicaldiagnosis of indeterminate thyroid nodules

Abstract Background: To explore the differential diagnostic value of multimodal ultrasound (US) in thyroid nodules with indeterminate cytological (IC) findings. Methods: A total of 61 thyroid nodules (Bethesda Ⅲ/Ⅳ/Ⅴ) that underwent both fine needle aspiration biopsy and surgical treatment were analyzed, including 37 malignant and 24 benign nodules. Differences in sonographic characteristics between the benign and malignant nodules were assessed. Logistic regression analysis was performed to construct the prediction models of conventional US, superb microvascular imaging (SMI), ultrasound elastography (UE), and multimodal US. Evaluation sensitivity, specificity, and accuracy of malignant thyroid nodules with IC using conventional US, SMI, UE, and multimodal US were performed. The receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) values were calculated and compared. Results: The sensitivity, specificity, and accuracy were 62.05%, 64.86%, and 63.93% for conventional US, 70.83%, 72.97%, and 72.13% for SMI, 83.33%, 83.78%, and 83.61% for UE, and 91.67%, 91.89%, and 91.80% for multimodal US, respectively. The AUC values for conventional US, SMI, UE, and multimodal US in evaluating benign and malignant thyroid nodules with IC were 63.7%, 71.9%, 83.6%, and 86.70%, respectively. Multimodal US results showed the best diagnostic efficacy in malignant nodule diagnosis. Conclusions: Initial clinical results suggest that conventional US, SMI, and UE are valuable in the differential diagnosis of thyroid nodules with IC. Multimodal US imaging improves the diagnostic efficacy in diagnosis of malignant nodules and has provides additional information for differentiating malignant and benign nodules.