不同甲状腺影像报告和数据系统在甲状腺结节分类诊断中的应用比较

Comparison of different thyroid imaging reporting and data system in the classification and diagnosis of thyroid nodules

目的:比较Park等、Kwak等制定的两种甲状腺影像报告和数据系统(TI-RADS)在甲状腺结节分类诊断中的应用价值。方法:回顾性分析288例患者共322个甲状腺结节的术前超声检查资料,分别采用两种TI-RADS分类标准对结节进行分类,以组织病理为金标准,构建受试者工作特征曲线(ROC曲线),分析并比较两种TI-RADS的诊断效能。结果:Park等的敏感度、特异度、准确率、阳性预测值(PPV)、阴性预测值(NPV)、曲线下面积(AUC)分别为91.9%、88.6%、89.8%、81%、95.4%、0.903;Kwak等制定的数值为TI-RADS99.1%、63.5%、75.8%、58.8%、99.3%、0.813。前者的特异度、准确率、PPV、AUC明显高于后者(P<0.001),而后者的敏感度则高于前者(P<0.05)。结论:两种TIRADS分类标准对甲状腺结节良恶性的诊断均具有较好的指导作用,而Kwak等制定的TI-RADS分类标准较Park等制定的更加简易,且敏感度高,更适用于临床。

Objective：To compare the diagnostic performance of the two thyroid imaging reporting and data system（TI-RADS）suggested by Park and Kwak in differentiating thyroid nodules.Methods：This retrospective study included ultrasonographic results of 322 thyroid nodules in 288 patients.All nodules were categorized according to the TI-RADS suggested by Park and Kwak respectively.Receiver operating characteristic curve（ROC）analyses were performed to assess the diagnostic efficacy of the different TI-RADS with histopathological results served as the reference standard.Results：The sensitivity,specificity,accuracy,positive predictive values（PPV）,negative predictive values（NPV）and area under curve（AUC）were 91.9%,88.6%,89.8%,81%,95.4% and 0.903 for TI-RADS suggested by Park;these were 99.1%,63.5%,75.8%,8.8%,99.3% and 0.813 for TI-RADS suggested by Kwak.The specificity,accuracy,PPV and AUC of TIRADS suggested by Park were significantly higher than those suggested by Kwak（all P〈0.001）.However,the sensitivity of the latter was significantly higher than that of the former（P〈0.05）.Conclusion：Both TI-RADS classifications suggested by Park and Kwak are significantly valuable in the differential diagnosis of thyroid nodules;however,the TI-RADS suggested by Kwak is simple made with higher sensitivity,and is more suitable for the clinical practice.