ATA指南、Kwak与ACR TI-RADS分类对甲状腺结节的诊断效能

Diagnostic efficacy of the ATA guidelines,the Kwak TI-RADS and the ACR TI-RADS for thyroid nodules

目的:对比2011 Kwak版甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System by Kwak,Kwak TI-RADS)、2015 ATA《成人甲状腺结节与分化型甲状腺癌指南》(ATA指南)及2017 ACR版甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR TI-RADS)3种方法对甲状腺良恶性结节的诊断效能。方法:回顾性分析265个甲状腺结节的超声特征,应用以上3种方法对结节进行诊断分级,以病理结果为金标准,构建受试者工作特征曲线(receiver operating characteristic,ROC)。结果:Kwak TI-RADS、ATA指南与ACR TIRADS的ROC曲线下面积(the area under the ROC curve,AUC)分别为0.914、0.829、0.910,三者对甲状腺结节均具有较高的诊断效能,其中Kwak TI-RADS与ACR TI-RADS诊断效能更高于ATA指南方法(P<0.05),Kwak TI-RADS与ACR TI-RADS分级方法的诊断效能间无显著差异(P>0.05);三者的最佳诊断值分别为Kwak TI-RADS 4c,高度可疑恶性,ACR TI-RADS 5。Kwak TI-RADS诊断恶性结节的准确率高于另外2种方法(P<0.05),ACR TI-RADS的特异度及阳性预测值较高、敏感度及阴性预测值较低,ATA指南对部分甲状腺结节无法进行明确分类。结论:Kwak TI-RADS、ATA指南及ACR TI-RADS对甲状腺结节的诊断均具有较好的诊断效能,其中Kwak TI-RADS与ACR TI-RADS诊断效能更高于ATA指南。

Objective:To compare the diagnostic efficacy of the 2011 thyroid imaging reporting and data system by Kwak(Kwak TI-RADS),2015 American Thyroid Association(ATA)management guidelines and 2017 American College of Radiology thyroid imaging reporting and data system(ACR TI-RADS)for benign and malignant thyroid nodules.Methods:The conventional ultrasound features of 265 thyroid nodules were retrospectively analyzed and the above three methods were applied to diagnose and grade the nodules.Based on the gold standard of pathological results,the receiver operating characteristic curve(ROC)was constructed.Results:The area under the ROC curve of Kwak TI-RADS,ATA guidelines grading and ACR TI-RADS classification was respectively 0.914,0.829,and 0.910,and they all had high diagnostic efficacy for thyroid nodules,among which the diagnostic efficacy of Kwak TI-RADS and ACR TI-RADS was higher than that of ATA guidelines(P<0.05),with no significant difference between Kwak TI-RADS and ACR TI-RADS(P>0.05).The optimal diagnostic value of these three methods was respectively Kwak TI-RADS 4c,highly suspected malignancy of ATA guidelines and ACR TI-RADS 5.The accuracy of Kwak TI-RADS in the diagnosis of malignant nodules was higher than that of the other two(P<0.05).The specificity and positive predictive value of ACR TI-RADS were higher,and its sensitivity and negative predictive value were lower than those of the other two.Therefore,some thyroid nodules could not be clearly classified by ATA guidelines.Conclusion:The three methods have good efficacy in the diagnosis of thyroid nodule,and the diagnostic efficacy of Kwak TI-RADS and ACR TI-RADS was higher than that of ATA guidelines.