ACR TI-RADS与ATA指南分级评估甲状腺结节的对比研究

Comparison between ACR TI-RADS and the recommendation of ATA in evaluation of thyroid nodule with ultrasound

目的:对比研究美国放射学会(ACR)甲状腺影像报告与数据系统(TI-RADS)分级与美国甲状腺协会(ATA)甲状腺诊治指南分级对甲状腺结节恶性风险评估的价值.方法:选取我院经病理证实的甲状腺结节148例(173个),分别应用ACR TI-RADS分级及ATA指南分级对结节进行评估,比较各分级的恶性百分比.以病理为对照,对比2种方式的诊断敏感度、特异度、阳性预测值、阴性预测值及Youden指数.采用ROC曲线确定ACR TI-RADS与ATA指南分级的较佳诊断临界值.结果:ACR TI-RADS分级TR2、TR3、TR4及TR5恶性结节百分比比较,差异均有统计学意义(χ^2=46.22,P<0.05).ATA指南分级的良性、极低危、低危、中危、高危中恶性百分比比较,差异均有统计学意义(χ^2=70.57,P<0.05).ACR TI-RADS分级与ATA指南分级ROC曲线下面积分别为0.812及0.842,两者诊断良恶性结节效率相近.ACR TI-RADS分级以≥TR5为界点时,ATA指南分级以≥高危为界点诊断恶性时,Youden指数分别达到最高,但ACR TI-RADS分级TR5的恶性百分比(58.6%,17/29)较ATA指南高危分级的恶性百分比(73.1%,19/26)低.结论:ACR TI-RADS分级与ATA指南分级均为临床提供了可行的甲状腺结节恶性风险分级,对甲状腺结节的恶性风险评估诊断价值均较高.ACR TI-RADS分级简单易行,可重复性高,更适合在基层医院推广应用.

Objective :To compare diagnostic values of ACR TI-RADS and the recommendation of ATA in evaluation of thyroid nodule with ultrasound. Methods: A total of 173 thyroid nodules of 148 patients were included and evaluated by criteria set by ACR TI-RADS and ATA. With pathology as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and Youden index of the two methodologies were calculated. And the two methodologies were evaluated and measured by ROC curve. Results: The malignancy rates under ACR TI-RADS category TR2 ,TR3 ,TR4 and TR5 nodules were 0,3.1%(2/64), 12.8%(10/78),58.6%(17/29),respectively. Malignancy rates under ATA of benign,very low,low,intermediate,and high suspicion for malignancy were 0,4.8%(1/21),4.4%(3/68), 10.7%(6/56) and 73.1%(19/26),respectively. There were significant differences inside each patterns respectively with ACR TI-RADS and ATA (P<0.05). Areas under the ROC curve of the ACR TI-RADS and ATA were 0.812 and 0.842. Best cut-off point for diagnosing malignant by ACR TI-RADS and ATA were MTR5 and Mhigh suspicion (Youden index=0.58,0.65). The percentage of malignancy in the ACR TI-RADS TR5 (58.6%) was lower than that in the ATA high-risk classification (73.1%). Conclusions:Both ACR TI-RADS and the ATA provide effective malignancy risk stratification for thyroid nodules. ACR TI-RADS is relatively simple and easy to use,and is more suitable for promotion and application in primary hospitals.