2015 ATA指南超声模式在Bethesda Ⅲ类甲状腺结节中的应用价值

The role of ATA (2015) guidelines in differentiation between malignant and benign of bethesda Ⅲ thyroid nodules

目的:探讨2015ATA指南超声模式对意义不明确的非典型病变(atypia of undetermined significance,AUS)和滤泡性病变(follicular lesion of undetermined significance,FLUS)的诊断价值。方法:选取最初经细针穿刺细胞学(fine needle aspiration,FNA)诊断为AUS/FLUS的204例甲状腺结节作为研究对象,分析并比较AUS及FLUS良恶性结节的临床资料及二维超声特征,对所有结节的二维超声图像行2015ATA指南超声模式分级标准进行分级,计算得出极低度、低度、中度及高度可疑恶性结节的恶性风险,使用受试者工作特征(ROC)曲线计算得出2015ATA超声模型鉴别AUS良恶性的最佳诊断界点,并根据诊断界点得出诊断效能等指标。结果:在AUS/FLUS良恶性结节之间,患者的年龄、性别及结节的大小差异无统计学意义(P>0.05);144例AUS中,恶性甲状腺结节多表现为不规则边界和微钙化且具有统计学意义(P=0.007,P=0.005);2015ATA指南超声模式对AUS类结节的良恶性评估有统计学意义(P=0.001),其极低度、低度、中度、高度可疑恶性结节的恶性率依次为0%、7.0%、64.3%、77.1%,恶性率随着分级的增高而增高,而在FLUS类结节良恶性鉴别诊断中差异无统计学意义;2015ATA对AUS诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值及曲线下面积分别为87.8%、87.4%、87.5%、94.7%、73.5%、0.90。结论:2015ATA指南有助于鉴别AUS的良恶性,将Bethesda Ⅲ类甲状腺结节细分为AUS和FLUS两类,在临床工作中,有助于对Bethesda Ⅲ类甲状腺结节更好的管理及治疗。

Objective： To evaluate the diagnostic value of the 2015 ATA ultrasound model for atypia of undetermined significance（ AUS） and follicular lesion of undetermined significance（ FLUS）. Methods： 204 thyroid nodules that were initially diagnosed as AUS/FLUS on fine needle aspiration（ FNA） were included in this study. The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules. The two-dimensional ultrasound images of all nodules were sorted by the 2015 ATA guideline ultrasound model grading criteria,and the malignant risk of different grading were calculated. In order to calculate the diagnosis and other indicators,the optimal threshold drawing from ROC curve is drawn to obtain the cut-off value of 2015 ATA guidelines.Results： There was no significant difference in age,gender and nodule size between benign and malignant nodules（ P〈0. 05）. Malignant nodules of 144 cases of AUS thyroid nodules had significantly higher reates of not well-circumscribed margin and presence of microcalcifications（ P = 0. 007,P = 0. 005）. There were significant differences in malignancy risk among the different US patterns defined by the 2015 ATA guidelines in AUS nodules,and the malignant of very low suspicion,low suspicion,intermediate suspicion,and high suspicion is 0%,7. 0%,64. 3%,77. 1%respectively. AUS nodules with higher suspicion of malignancy were associated with increased malignancy rates. However,there were no statistical differences in the malignancy rate among the ATA categories in FLUS nodules. The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area under the curve for 2015 ATA guidelines were estimated to be 87. 8% 、87. 4% 、87. 5% 、94. 7% 、73. 5%,and 0. 90 respectively. Conclusion：The 2015 ATA guideline contributes to the identification of benign and malignant AUS. The Bethesda Ⅲ thyroid nodules are subdivided into AUS and FLUS,which contribute to the better management and treatment of Bethesda Ⅲ thyroid nodules in clinical practice.