The value of ultrasound grayscale ratio in the diagnosis of papillary thyroid microcarcinomas and benign micronodules in patients with Hashimoto's thyroiditis: A two-center controlled study

Abstract

Objective: The value of ultrasound grayscale ratio (UGSR) in the diagnosis of papillary thyroid microcarcinomas (PTMCs) and benign micronodules (BMNs) has been recognized by some authors, but studies have not examined these aspects in patients with Hashimoto's thyroiditis (HT). This retrospective study investigated the value of UGSR in the diagnosis of PTMCs and BMNs in patients with HT using data from two medical centers.

Methods: Ultrasound images of 428 PTMCs in 368 patients with HT and 225 BMNs in 181 patients with HT in center A were retrospectively analyzed and compared to the ultrasound images of 412 PTMCs in 324 patients with HT and 315 BMNs in 229 patients with HT in medical center B. All of the cases were surgically confirmed. The UGSR was calculated as the ratio of the grayscale value of lesions to the surrounding normal thyroid tissues. The optimal UGSR thresholds for the PTMCs and BMNs in patients with HT from the two medical centers were determined using a receiver operating characteristic (ROC) curve. Furthermore, other statistics, including the area under the curve (AUC), the optimal UGSR threshold, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the two medical centers, were pair analyzed in this study.

Results: The UGSR of PTMCs and BMNs in patients with HT from medical center A were 0.513 (0.442, 0.592) and 0.857 (0.677, 0.977) (Z = -15.564, p = 0), and those from medical center B were 0.514 (0.431, 0.625) and 0.917 (0.705, 1.131) (Z = -15.564, p = 0). For both medical centers A and B, the AUC, optimal UGSR threshold, sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the UGSR in differentiating between PTMCs and BMNs in patients with HT were 0.870 and 0.889, 0.68 and 0.70, 0.921 and 0.898, 0.747 and 0.759, 0.874 and 0.829, 0.832 and 0.848, and 0.861 and 0.836, respectively. There were no significant differences in the UGSR for the PTMCs between patients from the two medical centers (Z = -0.815, p = 0.415), while there was a significant difference in the UGSR of the BMNs between patients from the two medical centers (Z = -3.637, p = 0).

Conclusion: In the context of HT, UGSR still has high sensitivity, accuracy, and stability in differentiating between PTMCs and BMNs, making it a complementary differentiator of thyroid imaging reporting and data systems. However, due to its low specificity, a comprehensive analysis of other ultrasound signs is required.

Keywords: Hashimoto’s thyroiditis; diagnosis; echogenicity; nodular goiters; papillary thyroid microcarcinomas; ultrasound grayscale ratio.