To evaluate the diagnostic value of ultrasound in isoechoic and hyperechoic thyroid nodules.

A retrospectively analysis was performed on the ultrasonographic data of 128 cases of isoechoic and hyperechoic thyroid nodules confirmed by surgery and pathology at the Third Affiliated Hospital of Soochow University from August 2019 to December 2020. Based on the pathological results as the gold standard, there were 94 cases of benign nodules and 34 cases of malignant nodules. The ultrasonic features of nodules, including echo, margin, growth mode, calcification, halo, echo texture, posterior echo, nodule-in-nodule architecture, cystic change, and blood flow, were evaluated. Independent sample t-test, χ² test, or Fisher's exact test was used for statistical comparison of ultrasonic features between groups. The diagnostic efficacy of each parameter was analyzed using the receiver operating characteristic (ROC) curve and the area under curve (AUC).

In the benign and malignant groups, irregular margin of the nodule (38.2% vs 5.3%, P＜0.001), vertical growth (17.6% vs 2.1%, P=0.004), calcification (73.5% vs 17.0%, P＜0.001), uneven echo texture (94.1% vs 55.3%, χ²=16.53, P＜0.001), and a little blood flow (79.4% vs 57.4%, P=0.017) all suggested the risk of malignancy. There was no difference in the presence or absence of halo between the two groups (P＞0.05). In nodules with halo, inconsistent halo thickness (84.2% vs 8.2%, χ²=37.58, P＜0.001) suggested the risk of malignancy. The diagnostic sensitivity of uneven echo texture of nodules (94.12%) was the highest, and the diagnostic specificity of vertical growth (97.87%) was the highest. The AUC and diagnostic accuracy of inconsistent sound halo thickness were the highest (0.880 and 89.71%, respectively).

Isoechoic and hyperechoic nodules with irregular edges, vertical growth, coarse calcification or microcalcification, inconsistent thickness of acoustic halo, uneven echo texture, and a little blood supply are helpful to the diagnosis of malignant nodules.