改良Kwak甲状腺影像报告和数据系统在甲状腺结节诊断中的应用价值

Application value of modified Kwak thyroid imaging reporting and data system in diagnosis of thyroid nodules

目的探讨改良Kwak甲状腺影像报告和数据系统（TI-RADS）在甲状腺结节诊断中的临床应用价值。方法以Kwak 5项恶性超声征象加上后方回声衰减、转移性淋巴结为依据,对369例甲状腺结节患者共513个结节进行TI-RADS评分分级;采用Logistic回归分析上述超声征象在甲状腺良恶性结节鉴别诊断中的价值;同时采用ROC曲线评价其诊断效能,并分析该方法组间和组内评分的一致性。结果 513个结节中TI-RADS评分2级73个（均为良性）,3级264个（恶性9个,良性255个）,4A级76个（恶性11个,良性65个）,4B级58个（恶性28个,良性30个）,4C级31个（恶性26个,良性5个）,5级11个（恶性10个,良性1个）。多元回归分析发现恶性结节的独立预测因子有实质性、纵横比〉1、边界不规则、微小钙化及转移性淋巴结,其OR值分别为4.128、6.064、7.541、17.237及21.534。恶性超声征象数目与恶性几率相关,TI-RADS评分2~5级结节的恶性百分比分别为0、3.41%、14.47%、48.28%、83.87%及90.91%;TI-RADS评分2~5级结节的ROC曲线下面积为0.904。组间和组内一致性检验的Kappa值分别为0.766±0.028和0.778±0.027。结论改良TI-RADS法中各恶性超声征象的OR值存在差异,微钙化和转移性淋巴结是最佳的独立预测因子;本方法结节的恶性百分率和理论值符合率较高并具有较好的可重复性,是一种实用、简便的鉴别甲状腺良恶性结节的方法。

Objective To investigate the clinical value of modified Kwak thyroid imaging reporting and data system（TI-RADS） in diagnosis of thyroid nodules.Methods By combining the 5 suspicious ultrasonic features suggested by Kwak with posterior attenuation,metastatic lymph nodes,513 nodules in 369 patients confirmed by pathology were categoried with modified TI-RADS.Logistic regression was used to analyze the value of above 7 features,then ROC curve of TI-RADS was plotted to evaluate the diagnostic efficacy.Meanwhile the interobeserver and intraobeserver agreement for the modified TI-RADS was calculated with Kappa statistics.Results The malignant nodules and benign nodules of category 2,3,4A,4B,4C,5 were 0/73,9/255,11/65,28/30,26/5 and 10/1,respectively.Multivariate logistic regression analysis found that the independent predictors of malignancy were solid component,taller-than-wide,irregular margins,microcalcification and metastatic lymph nodes,and the OR of these predictors were 4.128,6.064,7.541,17.237 and21.534,respectively.Furthermore,the risk of malignancy was in parallel with the number of suspicious features,the risk of category 2,3,4A,4B,4C,5 were 0,3.41%,14.47%,48.28%,83.87% and 90.91%,respectively.The area under the ROC curve was 0.904.The interobserver and intraobeserver agreement was substantial（Kappa value were 0.766 ±0.028 and0.778±0.027,respectively）.Conclusion The OR of suspicious ultrasonic features in the modified TI-RADS is different,in which the best independent predictors of malignancy is microcalcification and metastatic lymph nodes.The actual probability of malignancy is consistent with the theoretic risk of malignancy.Furthermore,the modified TI-RADS has good reproducibility.The modified Kwak TI-RADS is practical and convenient for differential diagnosis of thyroid nodules.