TI-RADS对甲状腺良恶性结节的诊断效能及一致性分析

The diagnostic efficacy and consistency analysis of TI-RADS for benign and malignant thyroid nodules

目的:分析TI-RADS对甲状腺良恶性结节的诊断效能,并评估观察者之间的一致性,了解其临床应用价值。方法:回顾性分析266枚经手术或细针穿刺活检(Fine needle aspiration,FNA)病理证实的甲状腺结节患者的资料及术前常规超声特点,由两名高年资超声医师,按目前公认的实性成分+低回声或极低回声、分叶状与不规则的边缘、纵横比>1、微钙化4个恶性指标判定,将结节分为3、4a、4b、4c、5类,以病理为金标准,分析TI-RADS各分类中恶性肿瘤的检出率。结果:两名超声医师对甲状腺结节TI-RADS分类存在一致性;TI-RADS 3、4a、4b、4c、5各分类的恶性肿瘤检出率分别为0%、5.3%、33.9%、52.2%、100.0%。结论:TI-RADS分类在超声评价甲状腺实性结节良恶性及临床管理上有重要的指导意义。

Objective: To evaluate the diagnostic efficacy of TI-RADS in thyroid benign nodules and to evaluate the consistency between observers. Methods: We retrospectively analyzed clinical data and characteristics of preoperative ultrasound of 266 patients with thyroid nodules confirmed by surgery or FNA. All the characteristics of ultrasound were confirmed by two experienced ultrasound physicians, according to the currently accepted standards, including solid composition with low echo or extremely low echo, lobulated and irregular edge, microcalcifications, and aspect ratio>1. All the nodules were divided into 3,4a, 4b, 4c, 5 classes with pathology as the gold standard. The detection rate of malignant tumor in each classification were analyzed. Results: Two ultrasound physicians were consistent in classification of TI-RADS in thyroid nodules. The detection rates of malignant tumor in TI-RADS 3, 4a, 4b, 4c and 5 were 0%, 5.3%, 33.9%, 52.2% and 100.0%, respectively. Conclusion: TI-RADS has an important guiding significance in ultrasonic evaluation of the benign and malignant thyroid nodules and clinical management.