ATA超声模型和ACR-TIRADS在甲状腺良、恶性结节的诊断价值

Value of ATA ultrasonic model and ACR-TIRADS in the diagnosis of benign and malignant thyroid nodules

目的比较美国甲状腺学会(ATA)超声模型和美国放射学会甲状腺成像报告和数据系统(ACR-TIRADS)对甲状腺结节良、恶性鉴别的诊断效能。方法收集521例甲状腺结节患者(713个结节)的基本临床资料和结节的超声特征,分别按照两种超声诊断模型分级。构建ROC曲线,并根据约登指数选取最佳诊断切点,比较其诊断效能。结果 713个结节中,良性结节345个(48.39%),恶性结节368个(51.61%);与良性结节相比,恶性结节具有明显较高比例的实性成分、极低回声或低回声、边缘不规则、纵横比≥1、微钙化等超声特征。ATA超声模型极低度可疑、低度可疑、中度可疑、高度可疑甲状腺结节的恶性率分别为0、18.25%、57.89%、90.03%(P<0.05);ACR-TIRADS分级2、3、4、5级甲状腺结节的恶性率分别0、8.00%、67.37%、90.12%(P<0.05)。ROC曲线分析显示,ATA超声模型的最佳诊断切点为中度可疑,ACR-TIRADS的最佳诊断切点为4级;与ATA超声模型相比,ACR-TIRADS具有较高的AUC、灵敏度和阴性预测值(0.926vs.0.920、96.7%vs.93.5%和95.9%vs.92.1%)(P<0.05)。结论两种超声报告系统对甲状腺结节的诊断均具有较高的临床应用价值,ACR-TIRADS稍优于ATA超声模型,特别是对于非特异性的结节。

Objective To compare the diagnostic efficiency of American Thyroid Association (ATA)ultrasonic model and thyroid imaging reporting and data system from American College of Radiology (ACR-TIRADS)for differentiating the benign and malignant thyroid nodules.Methods The clinical data and ultrasound features of 521patients including 713 thyroid nodules were collected. All the nodules were categorized based on ATA ultrasonic model and ACR-TIRADS.The ROC curve was constructed and the best diagnostic cut-off was selected according to the Youden index for comparing their diagnostic performance.Results Of 713thyroid nodules,345nodules (48.39%)were benign and 368nodules (51.61%)were malignant.Compared with benign nodules,the malignant nodules had the ultrasound features of higher proportion of solid component,markedly hypoechoic or hypoechoic,irregular margin,taller than wide≥1 and microcalcification.The rates of malignant nodules with very low,low,intermediate and high suspicion detected by ATA ultrasonic model were 0,18.25%,57.89% and 90.03%(P<0.05),while which at stage 2,3,4and 5classified by ACR-TIRADS were 0,8.00%,67.37% and 90.12%(P<0.05).ROC curve analysis showed that the best diagnostic cut-off of ATA ultrasonic model and ACR-TIRADS were intermediate suspicion and stage 4,respectively.Compared with ATA ultrasonic model,ACR-TIRADS had the higher AUC,sensitivity and negative predictive value in the diagnosis of thyroid nodules (0.926 vs.0.920,96.7% vs.93.5% and 95.9%vs.92.1%)(P<0.05).Conclusion Both ATA ultrasonic model and ACR-TIRADS have great clinical value in the diagnosis of benign and malignant thyroid nodules,but,ACR-TIRADS shows superiority over ATA ultrasonic model,especially for the nodules with unspecific pattern.