甲状腺结节超声恶性危险分层中国指南在老年患者甲状腺结节良恶性诊断中的应用价值

Value of C-TIRADS in the diagnosis of benign and malignant thyroid nodules in elderly patients

目的探讨2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)在老年患者甲状腺结节良恶性诊断中的应用价值。方法回顾性选取2020年1月至2022年10月在珠海市香洲区人民医院及中山大学附属第五医院治疗的老年患者225例(共359个甲状腺结节),收集所有结节的超声特征,并根据C-TIRADS及2017年美国放射学会甲状腺影像报告和数据系统(ACR-TIRADS)进行分类。以病理结果为金标准,与ACR-TIRADS比较,分析C-TIRADS的诊断效能。计量资料的比较采用t检验或秩和检验,计数资料的比较采用χ^(2)检验。结果病理结果证实,359个甲状腺结节中良性结节227个(63.23%),恶性结节132个(36.77%)。恶性结节最大径明显小于良性结节(t=6.730,P<0.01)。实性、极低回声、边缘模糊或甲状腺外扩展、垂直位和微钙化等超声特征越多,结节的恶性比例越高。C-TIRADS鉴别良恶性结节的最佳截断值为4B类,其特异度、阳性预测值及受试者工作特征曲线下面积均高于ACR-TIRADS(χ^(2)=11.836、5.222,Z=3.694,P<0.05或0.01)。结论C-TIRADS具有较好的甲状腺良恶性结节鉴别诊断能力,在减少老年患者不必要的甲状腺结节穿刺活检或手术治疗的同时,还可以简化超声评估流程,提高工作效率。

Objective To investigate the value of 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules(C-TIRADS)in the ultrasonic diagnosis of benign and malignant thyroid nodules in elderly patients.Methods Two hundred and twenty-five elderly patients with 359 thyroid nodules treated in the Xiangzhou District People's Hospital and the Fifth Affiliated Hospital of Sun Yat-sen University from January 2020 to October 2022 were retrospectively selected.The ultrasound features of all the thyroid nodules were collected,and all the nodules were categorized based on C-TIRADS and 2017 American College of Radiology Thyroid Imaging Reporting and Data System(ACR-TIRADS).The diagnostic efficacy of C-TIRADS was analyzed by comparing with ACR-TIRADS based on the pathological results as the gold standard.T test or Nonparametric test was used for comparison of measurement data,χ^(2) test was used for comparison of counting data.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficiency of C-TIRADS.Results Among 359 thyroid nodules,227 were benign(63.23%)and 132 were malignant(36.77%)by postoperative pathology.The maximum diameter of malignant nodules was significantly smaller than that of benign nodules(t=6.730,P<0.01).The thyroid nodules had a higher rate of malignancy with more ultrasound features including solid,markedly hypoechoic,ill-defined margin or extrathyroid extension,vertical orientation and microcalcification.The optimal truncation value of C-TIRADS in differentiating benign and malignant nodule was class 4B,and the specificity,positive predictive value and area under the ROC were higher than those of ACR-TIRADS(χ^(2)=11.836 and 5.222,Z=3.694,P<0.05 or P<0.01).Conclusion C-TIRADS has good diagnostic efficiency of thyroid nodules,which can reduce unnecessary thyroid nodule puncture biopsy or surgical treatment,and is helpful to simplify the ultrasound evaluation process and improve work efficiency.