实时超声弹性成像调整C-TIRADS 4类甲状腺结节的临床价值

Clinical value of real-time ultrasound elastography in adjusting the classification of thyroid C-TIRADS 4 nodules

目的探讨实时超声弹性成像(RTE)在调整中国超声甲状腺影像报告和数据系统(C-TIRADS)4类结节中的应用价值。方法选取我院经手术病理确诊的甲状腺结节患者72例,共计82个结节,均为C-TIRADS 4类,其中最大径<10 mm者35个,≥10 mm者47个。采用Asteria RTE评分法,将RTE评分<3分者C-TIRADS分类下调一级,≥3分者上调一级。以手术病理结果为金标准,绘制受试者工作特征曲线分析并比较RTE调整前、后C-TIRADS分类对其良恶性的鉴别诊断效能。结果82个结节中,C-TIRADS 4A类22个,4B类27个,4C类33个;RTE调整后C-TIRADS 3类17个,4A类8个,4B类16个,4C类19个,5类22个。RTE调整前、后C-TIRADS分类诊断甲状腺结节良恶性的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为90.4%、56.7%、78.0%、78.3%、77.3%和96.2%、76.7%、89.0%、87.7%、92.0%;其曲线下面积分别为0.735和0.881,差异有统计学意义(Z=2.869,P=0.004)。RTE调整后C-TIRADS分类对<10 mm及≥10 mm结节的诊断敏感性、特异性、准确率、阳性预测值及阴性预测值分别为95.0%、80.0%、88.6%、86.4%、92.3%和96.9%、80.0%、91.5%、91.2%、92.3%,曲线下面积分别为0.875和0.884,均高于调整前;其中RTE调整前、后对<10 mm结节曲线下面积比较(0.650 vs.0.875),差异有统计学意义(Z=3.211,P=0.001)。结论RTE可通过调整C-TIRADS 4类结节分类提高其鉴别良恶性诊断效能,尤其对于<10 mm者诊断效能更佳。

Objective To investigate the application value of real-time ultrasound elastography(RTE)in adjusting the classification of Chinese thyroid imaging reporting and date system(C-TIRADS)4 nodules.Methods A total of 82 nodules were selected from 72 patients with pathological surgery,all of which were classified as C-TIRADS 4,including 35 with maximum diameter<10 mm and 47 with maximum diameter≥10 mm.Taking the Asteria RTE scoring method,the C-TIRADS classification of nodules with RTE score<3 was downgraded one level and those with scores≥3 was upgraded one grade.Taking surgical pathology results as the golden standard,receiver operating characteristic(ROC)curves were drawn to analyze and compare the differential diagnostic efficacy of benign and malignant patients by C-TIRADS classification before and after RTE adjustment.Results Among the 82 nodules,there were 22 nodules in C-TIRADS 4A,27 nodules in C-TIRADS 4B,and 33 nodules in C-TIRADS 4C.After RTE adjustment,there were 17 nodules in C-TIRADS 3,8 nodules in category 4A,16 nodules in category 4B,19 nodules in category 4C and 22 nodules in category 5.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of C-TIRADS in distinguishing benign and malignant thyroid nodules before and after RTE adjustment were 90.4%,56.7%,78.0%,78.3%,77.3% and 96.2%,76.7%,89.0%,87.7%,92.0%,respectively.The area under the ROC curves were 0.735 and 0.881,respectively,the difference was statistically significant(Z=2.869,P=0.004).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value after RTE adjustment for nodules<10 mm and≥10 mm were 95.0%,80.0%,88.6%,86.4%,92.3% and 96.9%,80.0%,91.5%,91.2%,92.3%,respectively.The area under the ROC curves were 0.875 and 0.884,respectively.The area under the ROC curve of<10 mm nodules was significantly different before and after RTE adjustment(0.650 vs.0.875,Z=3.211,P=0.001).Conclusion RTE can improve the diagnostic efficiency for differentiating benign and malignant nodules by adjusting the C-TIRADS category 4 classification,especially for nodules<10 mm.