甲状腺结节超声恶性风险分层:C-TIRADS、ACR-TIRADS和EU-TIRADS的对比研究

Diagnostic performance of ultrasound-based risk stratification systems for thyroid nodules: comparison of the C-TIRADS with the ACR-TIRADS and EU-TIRADS

目的通过对比C-TIRADS、ACR-TIRADS及EU-TIRADS 3种不同版本甲状腺结节超声恶性风险分层系统,探讨其临床应用价值。方法按照3种TI-RADS的分类规则,回顾性分析2019年1月至2020年6月浙江大学医学院附属邵逸夫医院266例甲状腺结节患者的283枚甲状腺结节的超声图像特征,以病理结果为金标准,计算不同系统不同分类的恶性百分比,绘制ROC曲线,并计算曲线下面积(AUC)及最佳诊断截断值,比较3种TI-RADS的诊断效能,以及细针穿刺活检(fine needle aspiration,FNA)的推荐数量和恶性结节检出率。结果C-TIRADS、ACR-TIRADS及EU-TIRADS的AUC分别为0.80、0.66及0.61,C-TIRADS的AUC显著高于ACR-TIRADS和EU-TIRADS(均P<0.001),ACR-TIRADS的AUC显著高于EU-TIRADS(P=0.02)。C-TIRADS、ACR-TIRADS、EU-TIRADS的最佳诊断截断值分别为4C类、5类、5类,其对应的敏感性分别为95.27%、98.10%、99.53%,特异性分别为54.17%、33.33%、20.83%。另外,3种TI-RADS分类系统的FNA推荐数量及恶性结节检出率差异无统计学意义(均P>0.05),其FNA推荐具有较高的一致性(Kappa值>0.9)。结论C-TIRADS分类系统对甲状腺结节良恶性的诊断效能高于ACR-TIRADS和EU-TIRADS,其最佳诊断临界值为C-TIRADS 4C,三者在FNA推荐数量及恶性检出率方面具有较高的一致性。

Objective To compare the diagnostic values of C-TIRADS,ACR-TIRADS and EU-TIRADS.Methods According to the classification methods of the 3 guidelines,the ultrasonographic features of 283 thyroid nodules from 266 patients in Sir Run Run Shaw Hospital from January 2019 to June 2020 were analyzed retrospectively.The pathological results were taken as the gold standard,the malignant percentage of different classification was calculated,the ROC curve was plotted,the area under the ROC curve(AUC)and the best diagnostic cut-off value were calculated,and the diagnostic values of the three guidelines were compared.According to the FNA recommendations of the guidelines,the recommended number of thyroid nodules and the detection rate of malignant nodules in different guidelines were analyzed.Results The AUCs of C-TIRADS,ACR-TIRADS and EU-TIRADS were 0.80,0.66,0.61,respectively.The AUC of C-TIRADS was higher than those of ACR-TIRADS and EU-TIRADS(P<0.001,P<0.001).The best diagnostic cutoff values of C-TIRADS,ACR-TIRADS and EU-TIRADS were 4C,5 and 5,respectively.Under the critical points,the sensitivities of the 3 guidelines were 95.27%,98.10%,99.53%,the specificities were 54.17%,33.33%,20.83%,respectively.There was no significant difference in the number of FNA recommendations among the 3 guidelines(all P>0.05),their FNA recommendations were highly consistent(Kappa>0.9).Conclusions The diagnostic value of C-TIRADS in the classification of benign and malignant thyroid nodules is higher than those of ACR-TIRADS and EU-TIRADS.The best critical value for diagnosis of thyroid nodules is C-TIRADS 4C.The three guidelines are similar in the number of FNA recommendations and the detection rate of malignancy.