甲状腺影像报告和数据系统分类诊断甲状腺结节良恶性的准确性

Thyroid Imaging Reporting and Data System in Identifying Benign and Malignant Thyroid Nodules

目的 超声检查是发现甲状腺结节的主要手段,但其判断甲状腺结节良恶性的准确性较低,本研究探讨甲状腺超声影像报告和数据系统（TI-RADS）分类诊断标准在判断甲状腺结节良恶性中的应用价值。资料与方法 回顾性分析经手术病理证实且TI-RADS分类为3～5类的168例甲状腺结节患者（251个结节）的临床资料,均行超声检查,与术后病理结果进行对照,计算TI-RADS分类诊断甲状腺结节良恶性的敏感度、特异度、准确度、阳性预测值及阴性预测值,比较良恶性结节超声征象的差异。结果 手术病理诊断甲状腺良性结节94个,恶性结节157个;TIRADS分类诊断良性结节93个,恶性结节185个;两者诊断甲状腺良恶性结节的差异有统计学意义（χ^2=149.6,P〈0.01）。TI-RADS分类诊断甲状腺结节良恶性的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为91.2%（144/157）、85.1%（80/94）、89.3%（224/251）、91.2%（144/158）、86.0%（80/93）。甲状腺良恶性结节超声征象表现在纵横比、内部回声、形态、微小钙化和环形钙化等方面差异均有统计学意义（χ^2=8.7～121.4,P〈0.01）。结论 在甲状腺结节的超声检查中,TI-RADS分类诊断标准能较准确地判断结节的良恶性,是术前超声检查一项重要的分类诊断方法,对临床诊断和治疗具有重要的指导价值。

Purpose As a main method to detect thyroid nodules, ultrasonography seems to have a rather low accuracy in differentiating benign and malignant ones. The present study aims to explore the diagnostic value of thyroid imaging reporting and data system（TI-RADS） in identifying benign and malignant thyroid nodules. Materials and Methods A total of 168 patients with thyroid nodules confirmed pathologically（with 251 suspicious nodules） underwent ultrasonography and were further grouped into category 3-5 according to TI-RADS classification standard. The results were retrospectively compared with histopathological findings. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS classification in the diagnosis of benign and malignant thyroid nodules were calculated, and the differences in ultrasonic features between benign and malignant thyroid nodules were also compared. Results The surgical and pathological findings showed that 94 nodules were benign and 157 were sinister; TI-RADS regarded 93 nodules were benign and 185 were malignant. The difference of the two means of identification was significant（χ^2=149.6, P〈0.01）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS were 91.2%（144/157）, 85.1%（80/94）, 89.3%（224/251）, 91.2%（144/158） and 86.0%（80/93）, respectively. The ultrasonic manifestations of benign and malignant nodules were significantly different with regard to aspect ratio, echogenicity, shape, calcification inside the nodule（χ^2=8.7-121.4, P〈0.01）. Conclusion TI-RADS classification standards have a high accuracy in the differentiation of benign and malignant thyroid nodules as a means of ultrasound examination, and thus can serve as an important guiding method in clinical diagnosis and treatment.