甲状腺影像报告和数据系统与甲状腺细胞病理学报告系统的相关性研究

Study on the relationship between thyroid imaging reporting and data system and the Bethesda system for reporting thyroid cytopathology

目的对比甲状腺影像报告和数据系统（TI-RADS）与甲状腺细胞病理学Bethesda报告系统（TBSRTC）在甲状腺结节定性诊断中的效能和影响因素。方法回顾性分析2013年4月至2016年10月665例甲状腺结节患者（1 598个结节）的临床资料。患者分别采用TBSRTC和TI-RADS在术前对甲状腺结节进行定性诊断，并在术后行病理学诊断。评估TI-RADS和TBSRTC的诊断效能，并对两种方法诊断错误的因素进行分析。结果1 598个甲状腺结节中，术后病理学诊断恶性结节202个，良性结节1 396个。TBSRTC诊断恶性甲状腺结节的敏感度和特异度明显高于TI-RADS[85.64%（173/202）比74.75%（151/202）和91.76%（1 281/1 396）比87.11%（1 216/1 396），P〈0.01]。TBSRTC诊断直径〈1 cm恶性甲状腺结节阳性率明显高于TI-RADS[77.63%（59/76）比47.37%（36/76）]，差异有统计学意义（P〈0.01）；两者诊断直径≥ 1 cm恶性甲状腺结节阳性率比较差异无统计学意义（P〉0.05）。单因素分析结果显示，TI-RADS假阴性患者甲状腺结节直径明显小于良性甲状腺结节患者[（1.01 ± 0.48）cm比（1.51 ± 0.45）cm]，合并其他甲状腺疾病率明显高于良性甲状腺结节患者[41.18%（21/51）比11.32%（158/1 396）]，差异有统计学意义（P〈0.05）；TBSRTC假阳性患者甲状腺功能异常率明显高于恶性甲状腺结节患者[18.26%（21/115）比6.93%（14/202）]，差异有统计学意义（P〈0.05）。结论对于甲状腺结节的定性诊断需要TI-RADS和TBSRTC相互参照，而且需要结合患者的其他临床指标以提高对恶性甲状腺结节的检出率。

ObjectiveTo compare effect between thyroid imaging reporting and data system （TI-RADS） and the Bethesda system for reporting thyroid cytopathology （TBSRTC） in the qualitative diagnosis of thyroid nodule. MethodsThe clinical data of 665 patients with thyroid nodule （1 598 nodules） from April 2013 to October 2016 were retrospectively analyzed. TBSRTC and TI-RADS were used for qualitative diagnosis of thyroid nodule before operation. Pathological diagnosis was performed after the operation. The diagnostic effect of TI-RADS and TBSRTC were assessed, and the factors leading to the diagnostic errors were analyzed. ResultsOf 1 598 thyroid nodules, the pathological diagnosis showed that benign nodules were in 202, and malignant thyroid nodules were in 1 396. The diagnostic sensitivity and 85.64%（173/202） vs. 74.75%（151/202） and specificity of malignant nodules by TBSRTC were significantly higher than that by TI-RADS： 91.76% （1 281/1 396） vs. 87.11% （1 216/1 396）, and there was statistical difference （P〈0.01）. The diagnosis positive rate of malignant nodules with diameter 〈1 cm by TBSRTC was significantly higher than that by TI-RADS： 77.63% （59/76） vs. 47.37% （36/76）, and there was statistical difference （P〈0.01）; there was no statistical difference in diagnosis positive rate of malignant nodules with diameter ≥ 1 cm between 2 methods （P〉0.05）. Univariate analysis result showed that the diameter of thyroid nodules in patients with TI-RADS false negative was significantly smaller than that in patients with benign thyroid nodules： （1.01 ± 0.48） cm vs. （1.51 ± 0.45） cm, the incidence of malignant thyroid nodules combined with other thyroid diseases was significantly higher than that in patients with benign thyroid nodules： 41.18% （21/51） vs. 11.32% （158/1 396）, and there were statistical differences （P〈0.05）; the rate of thyroid dysfunction in patients with TBSRTC false positive was significantly higher than that in patients with malignant thyroid nodules： 18.26% （21/115） vs. 6.93% （14/202）, and there was statistical difference （P〈0.05）.ConclusionsThe qualitative diagnosis of thyroid nodule requires the cross-reference of TI-RADS and TBSRTC, and the combination of other clinical indicators of patients can improve the detection rate of malignant thyroid nodules.