2020中国超声甲状腺影像报告和数据系统在甲状腺结节鉴别诊断中的应用价值

The diagnostic performance of 2020 Chinese Ultrasound Thyroid Imaging Reporting and Data System in thyroid nodules

目的评估中国超声甲状腺影像报告和数据系统(C-TIRADS)在甲状腺结节鉴别诊断中的应用价值,并与Kwak等提出的超声甲状腺影像报告和数据系统(TIRADS)(K-TIRADS)、美国放射学会提出的TIRADS(ACR-TIRADS)比较。方法回顾性收集2018年1月至2020年11月济宁医学院附属医院甲状腺外科1750例患者的2029个甲状腺结节的资料,其中男328例,女1422例,年龄6~86(47±12)岁。以结节为统计学单位,按结节大小分为≤1.0 cm结节组(997个)和>1.0 cm结节组(1032个)。通过3种TIRADS分别对所有结节进行恶性风险分层并预测良恶性。以病理结果为参考标准,构建受试者工作特征(ROC)曲线分析并比较3种TIRADS鉴别诊断甲状腺结节的价值。结果根据ROC曲线分析,C-TIRADS、K-TIRADS、ACR-TIRADS在两组结节中的最佳诊断点分别为4A、4b、4。对于恶性结节的诊断,在≤1.0 cm组和>1.0 cm组,C-TIRADS的曲线下面积(AUC)值分别为0.772、0.892,显著高于K-TIRADS(0.762、0.869)和ACR-TIRADS(0.735、0.832)(P<0.05)。C-TIRADS的灵敏度、特异度、准确性、阳性预测值、阴性预测值分别为94.99%、59.41%、86.46%、88.13%、78.89%(≤1.0 cm结节组)和88.34%、90.05%、89.34%、86.33%、91.57%(>1.0 cm结节组),3种TIRADS中,C-TIRADS在两组结节中的灵敏度、准确性和阴性预测值均最高。结论3种TIRADS均具有较高的诊断价值,C-TIRADS的整体效能最佳,可有效地辅助临床医生做出管理意见,值得在临床中推广应用。

Objective To evaluate the diagnostic performance of the Chinese Ultrasound Thyroid Imaging Reporting and Data System(C-TIRADS)in thyroid nodules,and to compare it with the TIRADS proposed by Kwak et al.(K-TIRADS)and the TIRADS proposed by the American College of Radiology(ACR-TIRADS).Methods The data of 1750 patients with 2029 thyroid nodules in the Department of Thyroid Surgery,the Affiliated Hospital of Jining Medical University from January 2018 to November 2020 was retrospectively collected.Among them,there were 328 males and 1422 females,aged from 6 to 86 with an average of(47±12)years.The nodules were divided into≤1.0 cm group(n=997)and>1.0 cm group(n=1032)based on the size of the nodules.The stratification for malignant risk and the determination of benign or malignancy of the nodules was evaluated using the C-TIRADS,K-TIRADS and ACR-TIRADS,respectively.The receiver operating characteristic(ROC)curve analysis was performed to compare the diagnostic performance of the aforementioned three kinds of TIRADS using pathological results as the referent standard.Results The optimal diagnosis points in the determination of malignant nodules of C-TIRADS,K-TIRADS and ACR-TIRADS in the two groups were 4A,4b and 4 respectively according to ROC curve analysis.For the diagnosis of the malignant nodules,the C-TIRADS achieved with an AUC value of 0.772 and 0.892 in the≤1.0 cm group and>1.0 cm group,respectively,which was significantly higher than K-TIRADS(AUC=0.762 and 0.869,respectively)and ACR-TIRADS(AUC=0.735 and 0.832,respectively)(P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of C-TIRADS were 94.99%,59.41%,86.46%,88.13%,78.89%(≤1.0 cm group)and 88.34%,90.05%,89.34%,86.33%,91.57%(>1.0 cm group),respectively.C-TIRADS had the highest sensitivity,accuracy,and negative predictive value in the determination of malignant nodules in both groups compared to the other two kinds of TIRADS.Conclusions The three kinds of TIRADS all have high diagnostic performance for the determination of the malignant nodules,and the C-TIRADS has the best overall efficacy,which can effectively assist clinicians for medical decision,and is worth to be popularized and applied in the clinical setting.