ATA、ACR-TIRADS和EU-TIRADS在甲状腺结节良恶性超声诊断中的应用比较

Comparison of the application of ATA,ACR TI-RADS and EU-TIRADS in the diagnosis of benign and malignant thyroid nodules

目的:探讨2015年美国甲状腺学会(American Thyroid Association,ATA)《成人甲状腺结节与分化型甲状腺癌诊治指南》、2017年美国放射学会甲状腺影像报告与数据系统(Amer ican Society of Radiology Thyroid Imaging Reporting and Data System,ACR TI-RADS)和欧洲甲状腺协会发布的甲状腺影像报告与数据系统(European Thyroid Association-Thyroid Imaging Reporting and Data System,EU-TIRADS)在甲状腺结节良恶性超声诊断中的应用比较。方法:回顾性分析2019年3月至2021年5月池州市人民医院收治的105例甲状腺结节患者的超声及病理资料。以病理结果作为诊断金标准,观察ATA、ACR-TIRADS和EU-TIRADS对甲状腺结节良恶性的诊断效果。结果:纳入观察的105个甲状腺结节经病理诊断,良、恶性分别占60.00%(63/105)、40.00%(42/105)。参照金标准,ATA、ACR-TIRADS和EU-TIRADS随超声分类级别增加,恶性率呈升高趋势。3种超声分类诊断的准确度依次为84.76%、86.67%、87.62%,敏感度为90.48%、85.71%、83.33%,特异度80.95%、87.30%、90.48%,差异均无统计学意义(χ^(2)=0.377、χ^(2)=0.952、χ^(2)=2.497,P>0.05)。受试者工作特征(receiver operating character i st i c,ROC)曲线显示ATA、ACR-TIRADS、EUTIRADS对甲状腺结节良恶性诊断的曲线下面积(area under the curve,AUC)依次为0.843、0.901和0.898,差异无统计学意义(Z=1.368、Z=1.247,P>0.05)。结论:ATA、ACR-TIRADS和EUTIRADS对甲状腺结节良恶性的诊断效果均较好,临床中超声医师可结合自身经验水平和分类诊断标准的掌握程度酌情选择。

Objective:To compare the application of 2015 American Thyroid Association guidelines for the diagnosis and treatment of adult thyroid nodules and differentiated thyroid cancer(ATA),2017 American Society of Radiology Thyroid Imaging Report and Data System(ACR TI-RADS)and European Thyroid Association Thyroid Imaging Report and Data System(EU-TIRADS)in the diagnosis of benign and malignant thyroid nodules.Methods:The ultrasonic and pathological data of 105 patients with thyroid nodules treated in Chizhou People’s Hospital from March 2019 to May 2021 were analyzed retrospectively.Pathological results were used as the gold standard for diagnosis.The diagnostic effects of ATA,ACR TI-RADS and EU-TIRADS on benign and malignant thyroid nodules were observed.Results:The 105 thyroid nodules included in the observation were pathologically diagnosed.The benign and malignant accounted for 60.00%(63/105)and 40.00%(42/105),respectively.According to the gold standard,the malignant rate of ATA,ACR TI-RADS and EU-TIRADS increased with the increase of ultrasonic classification level.The accuracy of three ultrasonic classification diagnosis was 84.76%,86.67%,87.62%,and the sensitivity was 90.48%,85.71%,83.33%,and the specificity was 80.95%,87.30%and 90.48%(χ^(2)=0.377,χ^(2)=0.952,χ^(2)=2.497,P>0.05).The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of ATA,ACR TI-RADS and EU-TIRADS in the diagnosis of benign and malignant thyroid nodules were 0.845,0.899 and 0.898 respectively,with no significant difference(Z=1.368,Z=1.247,P>0.05).Conclusion:ACR-TIRADS and EU-TIRADS are effective in the diagnosis of benign and malignant thyroid nodules.Ultrasound doctors can choose according to their own experience and mastery of classification diagnostic criteria.