ACRTI-RADS、Kwak T-RADSI与C-TIRADS评估甲状腺良、恶性结节

ACR TI-RADS,Kwak TI-RADS and C-TIRADS for evaluating benign and malignant thyroid nodules

目的观察美国放射学会(ACR)甲状腺影像报告和数据系统(TI-RADS)、Kwak TI-RADS与C-TIRADS 3种分类系统评估甲状腺良、恶性结节的价值。方法观察959例甲状腺结节患者共1523个结节的术前超声特征,分别根据ACR TI-RADS、Kwak TI-RADS与C-TIRADS标准进行分类,计算结节恶性率;绘制受试者工作特征曲线,比较3种标准的诊断效能,评价超声分类结果之间及其与术后病理结果的一致性。结果根据ACR TI-RADS及C-TIRADS判断时,恶性率均处于预估范围内;以Kwak TI-RADS判断时,K-TR3类实际恶性率低于、K-TR5类实际恶性率高于预估范围,其余分类恶性率均处于预估范围内。以ACR TI-RADS≥5类、Kwak TI-RADS≥4c类及C-TIRADS≥4b类为截断值,3种标准判断甲状腺恶性结节的曲线下面积分别为0.931、0.937及0.938。除C-TR5和K-TR5类外,3种分类结果与病理诊断的一致性均随分类级别升高而增加,ACR TI-RADS及Kwak TI-RADS与病理的一致性最佳(Kappa=0.73、0.71,P均<0.05);C-TIRADS≥4c类与病理结果的一致性最佳(Kappa=0.73,P<0.05)。以3种分类标准对应的截断值判断结节性质,C-TR4b与A-TR5分类的一致性较好(Kappa=0.72,P<0.05),K-TR4c与C-TR4b、A-TR5的一致性均极好(Kappa=0.84、0.85,P均<0.05)。结论ACR TI-RADS、Kwak TI-RADS与C-TIRADS评估甲状腺良、恶性结节均有较高价值,与病理诊断的一致性较好。

Objective To observe the value of American College of Radiology(ACR)thyroid imaging report and data system(TI-RADS),Kwak TI-RADS and C-TIRADS for evaluating benign and malignant thyroid nodules.Methods Preoperative ultrasonographic features of 1523 thyroid nodules in 959 patients were retrospectively analyzed.ACR TI-RADS,Kwak TI-RADS and C-TIRADS were used to classify the nodules,and the malignant rate of nodules was calculated.The diagnostic efficacy of the above three classification criteria was compared using receiver operating characteristic curves.The consistencies of the ultrasonic classification results,ultrasonic classification results and the postoperative pathological results were evaluated.Results According to ACR TI-RADS and C-TIRADS,the malignancy rate of thyroid nodules was within the range predicted by all classifications.According to Kwak TI-RADS,the actual malignancy rate of K-TR3 was lower than the predicted range,the actual malignancy rate of K-TR5 was higher than the predicted range,and the malignancy rates of other categories were all within the predicted ranges.Taken ACR TI-RADS≥5,Kwak TI-RADS≥4 c and C-TIRADS≥4 b as the cut-off values,the area under the curve of malignant thyroid nodules according to ACR TI-RADS,Kwak TI-RADS and C-TIRADS was 0.931,0.937 and 0.938,respectively.Except C-TR5 and K-TR5,with the increase of classification levels,the consistency of the three classifications and pathological results increased.ACR TI-RADS and Kwak TI-RADS had the best consistency with pathological diagnosis when corresponding to the cut-off value(Kappa=0.73,0.71,both P<0.05).The consistency between C-TIRADS≥4 c and pathological diagnosis was the best(Kappa=0.73,P<0.05).According to the truncation values corresponding to the three classifications,the classified results of C-TR4 b and A-TR5 were in good agreements(Kappa=0.72,P<0.05),and of K-TR4 C and C-TR4 B and A-TR5 were in excellent agreements(Kappa=0.84,0.85,both P<0.05).Conclusion ACR TI-RADS,Kwak TI-RADS and C-TIRADS had high diagnostic value for evaluating benign and malignant thyroid nodules and good consistencies with pathological results.