[The role of SWE and ATA(2015) guidelines combined mode in differentiation malignant from benign of Bethesda Ⅲ thyroid nodules].

Objective: To evaluate the diagnostic value of the ATA (2015) ultrasound model, shear wave elastography (SWE), and ATA (2015)+SWE combinative modality for the diagnostic efficiency in thyroid nodules with Bethesda Classification Ⅲ indeterminate cytology, determine the diagnostic value of ultrasonography in Bethesda Classification Ⅲ indeterminate cytology. Method: 216 thyroid nodules that were initially diagnosed as AUS/FLUS by fine needle aspiration (FNA) were included in this study. The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules. The two-dimensional ultrasound images of all nodules were sorted by the 2015ATA guideline ultrasound model grading criteria. The maximum and average shear wave velocity (SWV) values were obtained from multiple SWV measurement under the VTIQ speed mode. The optimal threshold drawing from ROC curve and diagnostic performance of single and combinative modality were calculated. Result: ①There was no significant difference in age, sex and nodule size between benign and malignant nodules ( P >0.05). Malignant nodules of 152 cases of AUS thyroid nodules had significantly higher rates of not well-circumscribed margin and presence of microcalcifications ( P =0.005, P =0.004). ②There were significant differences in malignancy risk among the different US patterns defined by the 2015 ATA guidelines in AUS nodules. ③The maximum and mean SWV of AUS/FLUS nodules measured in VTIQ mode were statistically significant in evaluating benign and malignant nodules. ④The area under ROC curves of ATA (2015)+SWE combined mode was 0.912, larger than single diagnosis mode ［ATA (2015):0.854, SWE: 0.862］. Conclusion: SWE can not only compensate for the deficiency of ATA (2015) in the diagnosis of benign and malignant FLUS thyroid nodules, but also effectively improve the diagnostic performance of ATA (2015) in the differentiation of benign and malignant AUS thyroid nodules.