2016版《甲状腺结节超声诊断指南》与《甲状腺影像报告及数据系统诊断标准》在甲状腺结节诊断中对比研究

Comparative study of 2016 edition of thyroid nodules ultrasonography diagnostic guidelines and TI-RADS diagnostic criteria in the diagnosis of thyroid nodules

目的对比分析2016美国临床内分泌协会(AACE)/美国内分泌学院(ACE)/内分泌学相关医学指南(AME)甲状腺超声诊断指南与甲状腺影像学报告及数据系统(TI-RADS)诊断标准对甲状腺结节良恶性的诊断价值。方法按TI-RADS分类系统中的评分标准评分,以病理检查结果为金标准,回顾性分析150例患者共203个甲状腺结节的二维超声及彩色多普勒超声检查结果,采用Mec Nemar检验及构建患者的工作特征(receiver operating characteristic,ROC)曲线比较分析2016AACE/ACE/AME甲状腺超声诊断指南与TI-RADS分类系统对甲状腺良恶性结节的超声诊断意义。结果恶性结节75个,良性结节128个,2种评价方法对比分析,2016AACE/ACE/AME甲状腺超声诊断指南的灵敏度、特异度及准确度分别为84%、83%和84%,TI-RADS的敏感度、特异度及准确度分别为84%、61%和76%,2016AACE/ACE/AME甲状腺超声诊断指南对甲状腺结节诊断的特异度、准确度要高于TI-RADS,2种方法比较差异无统计学意义(P>0.05),但2种方法结合后,ROC曲线下面积为0.911,特异度、准确度及诊断价值高于单一方法。结论 2016AACE/ACE/AME版甲状腺超声诊断指南在甲状腺结节良恶性鉴别中具有较高的实用价值,是TI-RADS分类系统的良好补充,两者结合能够提高甲状腺结节良恶性的诊断。

Objective To investigate the value of ultrasound in the differential diagnosis of benign and malig- nant thyroid nodules by the TI-RADS classification system and 2016 edition of the guidelines in the differentiation of benign and malignant thyroid nodules. Methods One hundred and fifty patients with 203 thyroid nodules underwent two-dimensional ultrasound and color Doppler ultrasound, The nodules were graded by TI-RADS and proved by patho- logic findings. MecNemar method and Receiver operating characteristic curve （ROC） were established to compare the value of TI-RADS and the 2016 edition of the guidelines in differentiation of thyroid nodules. Results Seventy-five malignant nodules, 128 benign nodules, two methods of evaluation were analyzed . The sensitivity,specificity and ac- curacy of 2016 edition of the guidelines were 84%, 83%, and 84% respectively,a little higher than those of TI-RADS, which were 84%,61%,and 76% （P〉0.05）. The combination of the two methods could bring higher sensitivity,speci- ficity and accuracy than single method.The AUC for the combination of the two methods was 0.911 ,with significantly higher diagnosis accuracy than single method. Conclusion The 2016 edition of the guidelines for the diagnosis of thyroid uhrasound is of high practical value in the differential diagnosis of benign and malignant thyroid nodules. The combination of T1-RADS and the 2016 edition of the guidelines could improve the differentiation of thyroid nodules.