ObjectiveTo assess the significance of ultrasonic refined scoring method based on thyroid imaging reporting and data system(TI-RADS) combined with serum thyroid stimulating hormone(TSH) level in the differentiation diagnosis of benign and malignant thyroid nodules.

MethodsThe refined scoring of the boundary, aspect ratio, echo and calcification of thyroid nodules in ultrasonoscopy in patients treated with operation based on TI-RADS grading system combined with serum level of TSH on admission were analyzed to draw the receiver operating characteristic(ROC) curve and calculate the area under ROC curve(AUC).The value of serum level of TSH, ultrasonic refined scoring method and both combination in the differentiation diagnosis of benign and malignant thyroid nodules were evaluated.

ResultsThe ROC analysis showed that the sensitivity and specificity of ultrasonic refined scoring method in differentiating benign and malignant thyroid nodules were 88.6% and 83.9%, respectively.The AUC was 0.779(95%CI:0.718 to 0.839).When the Youden's index was the largest, the optimal critical value of ultrasonic refined scoring method was 9 points, and the nodules with score ≥ 9 and < 9 points were malignant and benign, respectively.The sensitivity and specificity of serum level of TSH in distinguishing benign and malignant thyroid nodules were 71.1% and 50.9%, recpectively, and the AUC was 0.703(95%CI:0.624 to 0.782).When the Youden's index was the largest, the optimal critical value was 2.31 mIU/L, and the sensitivity, accuracy and specificity of ultrasonic refined scoring method combined with serum TSH value in distinguishing benign and malignant thyroid nodules were 90.1%, 84.5% and 84.3%, respectively.

ConclusionsThe ultrasonic refined scoring method based on TI-RADS combined with serum level of TSH in the differentiation diagnosis of benign and malignant thyroid nodules can further improve the diagnostic coincidence rate, and reduce the rate of thyroid nodule biopsy or operation.