ACR-TIRADS与C-TIRADS分级在甲状腺良恶性结节鉴别诊断中的价值比较

Comparison of ACR-TIRADS and C-TIRADS grading in differential diagnosis of benign and malignant thyroid nodules

目的:对比分析2017年美国放射学院发布的甲状腺超声影像报告和数据系统(ACR TI-RADS)和2020中国超声甲状腺影像报告和数据系统(C-TIRADS)在甲状腺结节良恶性的鉴别诊断效能。方法:选取2016年9月—2020年6月在深圳市龙岗区第三人民医院超声影像科行超声检查并经甲状腺穿刺活检或手术治疗以明确病理结果的290例甲状腺结节患者,共300个结节,根据ACR-TIRADS、C-TIRADS对甲状腺结节超声图像进行回顾性分级,以最终病理结果为金标准,计算不同风险分层的恶性百分比,并绘制ROC曲线,比较这两种分层系统ROC曲线下面积(area under curve,AUC)、诊断灵敏度、特异度、准确率,获得最佳截断值并评估其诊断效能。结果:ACR-TIRADS与C-TIRADS分类的ROC曲线下面积分别为0.907、0.875,差异无统计学意义(P>0.05)。ACR-TIRADS诊断甲状腺恶性结节最佳截断值为4级,而C-TIRADS诊断甲状腺恶性结节最佳截断值为4A级。ACR-TIRADS诊断甲状腺结节良恶性的灵敏度为75.79%,特异度为92.28%,阳性预测值为68.3%,阴性预测值为94.6%;C-TIRADS诊断甲状腺结节良恶性的灵敏度为64.8%,特异度为95.12%,阳性预测值为74.5%,阴性预测值为92.5%。结论:ACR-TIRADS与C-TIRADS两种不同的风险等级分层方法对甲状腺结节良恶性均具有较高的鉴别诊断效能,均可在临床推广应用。

Objective To compare the value of American College of Radiology thyroid imaging reporting and data system(ACRTIRADS)and Chinese thyroid imaging reporting and data system(C-TIRADS)in differentiation of benign and malignant thyroid nodules.Methods A total of 300 nodules were selected from 290 patients with thyroid nodules who underwent ultrasonography and underwent thyroid biopsy or surgical treatment in the Department of Ultrasound and Imaging of the Third People's Hospital of Longgang District of Shenzhen from September 2016 to June 2020 to clarify the pathological results.According to ACR-TIRADS and C-TIRADS,ultrasound images of thyroid nodules were retrospectively graded.The final pathological results,as the gold standard,the percentage of malignancy in different risk stratification was calculated and the ROC curve was further constructed.The area under ROC curve,diagnostic sensitivity,specificity and accuracy of the two stratified systems were compared to obtain the cut-off valve to evaluate their efficacy.Results The area under ROC curve of ACR-TIRADS and C-TIRADS was 0.907 and 0.875,respectively,with no significant difference(P>0.05).In all 300 thyroid nodules,cut-off valve of two methods was ACR-TIRADS category 4 and C-TIRADS category 4A.The sensitivity,specificity,positive and negative predictive value of benign and malignant thyroid nodes based on the ACR-TIRADS and C-TIRADS classification were 75.79%,92.28%,68.3%,94.6%,64.8%,95.12%,74.5%,92.5%,respectively.Conclusion ACR-TIRADS and C-TIRADS have high diagnostic efficacy in benign and malignant diagnosis of thyroid nodules,and should be widely applied in clinical.C-TIRADS has higher specificity but lower sensitivity than those of ACR-TIADS.