甲状腺结节超声风险分层2种方法的对比

Comparison between two malignancy risk stratification methods of ultrasound for thyroid nodules

目的:比较美国放射学会(ACR)甲状腺影像报告与数据系统(TI-RADS)和2015年美国甲状腺学会(ATA)恶性风险分层在甲状腺结节风险分层中的临床应用价值。方法:选取山东大学齐鲁医院经病理证实的242例患者311个甲状腺结节,应用TIRADS和ATA恶性风险分层对结节进行分级。构建受试者工作特征(ROC)曲线,评价2种分级方法的诊断价值。评价2种分级方法在指导结节针吸细胞学(FNA)检查中的表现。结果:所有结节均可行TIRADS分级,有40个结节不能进行ATA恶性风险分层。2种分级方法不同风险等级恶性率的差异均有统计学意义(P<0.05)。ATA恶性风险分层敏感度显著高于TIRADS(P<0.001),TIRADS特异度显著高于ATA恶性风险分层(P<0.001)。TIRADS曲线下面积略高于ATA恶性风险分层,差异无统计学意义(P=0.494)。TIRADS和ATA恶性风险分层的FNA结果恶性率和恶性结节穿刺率差异无统计学意义(P=0.121、0.838),TIRADS良性结节穿刺率显著低于ATA恶性风险分层(P<0.05)。结论:TIRADS和ATA恶性风险分层均可对甲状腺结节进行有效的风险分层。TIRADS曲线下面积略高于ATA恶性风险分层。TIRADS可显著减少对良性结节行不必要的穿刺活检。

Objective:To compare the clinical significance of the American College of Radiology(ACR)Thyroid Imaging Reporting and Data System(TIRADS)with 2015 American Thyroid Association(ATA)malignancy risk stratification in the management of thyroid nodules risk stratification Methods:242 patients with 311 thyroid nodules were enrolled.All nodules were categorized on the basis of ACR TIRADS and ATA risk stratification.Receiver operating characteristic(ROC)curve was used to analyze their diagnostic value.Their directive function for fine needle aspiration biopsy was also assessed.Results:All nodules could be categorized based on TIRADS.40 nodules did not meet the criteria of ATA risk stratification.The difference between categories was significant in both TIRADS and ATA risk stratification(P<0.05).The sensitivity of ATA risk stratification was significantly higher than TIRADS,whereas specificity was significantly lower than TIRADS(P<0.001).Area under curve of TIRADS was a little higher than ATA,but there was no statistical significance(P=0.494).The biopsy confirmed as malignancy rate and malignant nodules that would be biopsied rate had no statistical difference between TIRADS and ATA risk stratification(P=0.121,0.838).The benign nodules that would be biopsied rate of TIRADS was significantly lower than ATA risk stratification(P<0.05).Conclusions:Both TIRADS and ATA risk stratification provide effective malignancy risk stratification for thyroid nodules.Area under curve of TIRADS was a little more than ATA risk stratification,though not significantly.TIRADS had a better performance in avoiding unnecessary biopsy for benign nodules.