C-TIRADS与ACR TI-RADS对甲状腺良恶性结节鉴别诊断价值的对比研究

Comparative study of the differential diagnostic value of C-TIRADS and ACR TI-RADS in benign and malignant thyroid nodules

目的:通过对比并验证2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)与2017年美国放射学会提出的甲状腺成像报告和数据系统(ACR TI-RADS)对甲状腺结节恶性风险分层评估的诊断价值。方法:选取2019年1月-2021年11月在我院行甲状腺超声检查并住院完成手术治疗的甲状腺结节患者,回顾性分析258个结节的超声图像特征,对所有纳入研究的结节分别采用C-TIRADS和ACR TI-RADS指南进行评估,以手术病理结果为金标准,绘制ROC曲线,并根据约登指数选取最佳截断值,比较两种指南的诊断效能。结果:C-TIRADS和ACR TI-RADS诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确度及ROC曲线下面积(AUC)分别为87.9%、80.3%、84.4%、84.7%、84.5%、0.904和70.2%、89.7%、89.2%、71.4%、79.1%、0.879。两种指南的敏感度、特异度、阴性预测值差异具有统计学意义(P<0.05),阳性预测值、准确度和AUC差异无统计学意义(P>0.05)。对于直径≤1 cm的亚组结节,C-TIRADS和ACR TI-RADS的敏感度和ROC曲线下面积分别为88.5%、0.927和72.4%、0.881,二者差异具有统计学意义(P<0.05);C-TIRADS和ACR TI-RADS的特异度、阳性预测值、阴性预测值、准确度差异无统计学意义(P>0.05)。另外,依据两种指南的FNA活检标准,C-TIRADS的不必要穿刺率和恶性结节的检出率均高于ACR TI-RADS,但二者差异无统计学意义(P>0.05)。结论:两种指南对甲状腺良恶性结节鉴别均具有较高的诊断效能,C-TIRADS指南具有较高的敏感度,ACR TI-RADS指南具有较高的特异度;在直径≤1 cm的亚组结节中,C-TIRADS指南的诊断效能优于ACR TI-RADS指南。

Objective:To compare and verify the diagnostic value of the 2020 Chinese guidelines for ultrasound malignant risk stratification of thyroid nodules(C-TIRADS)and the 2017 thyroid imaging reporting and data system(TI-RADS)proposed by the American college of radiology(ACR)in the assessment of malignant risk stratification of thyroid nodules.Methods:From January 2019 to November 2021,258 thyroid nodules underwent thyroid ultrasonographic examination and operation in our hospital.The ultrasonographic image features of 258 nodules were retrospectively analyzed.All the nodules included in the study were evaluated by C-TIRADS and ACR TI-RADS guidelines respectively.The ROC curve was constructed according to the surgical pathological results as the gold standard,and the best diagnostic cut-off was selected according to the Youden index to compare the diagnostic performance of the two guidelines.Results:The sensitivity,specificity,positive,negative,accuracy,and area under ROC curve(AUC)of C-TIRADS and ACR TI-RADS in the diagnosis of benign and malignant thyroid nodules were 87.9%,80.3%,84.4%,84.7%,84.5%,0.904 and 70.2%,89.7%,89.2%,71.4%,79.1%,0.879 respectively.The differences in sensitivity,specificity and negative predictive value between the two guidelines were statistically significant(P<0.05),while the differences in positive predictive value,accuracy and AUC were not statistically significant(P>0.05).For subgroups≤1 cm in diameter,the sensitivity and area under ROC curve of C-TIRADS and ACR TI-RADS were 88.5%,0.927 and 72.4%,0.881 respectively,and the differences were statistically significant(P<0.05).There was no significant difference in specificity,positive predictive value,negative predictive value and accuracy of C-TIRADS and ACR TI-RADS(P>0.05).In addition,according to the FNA biopsy criteria in the two guidelines,the unnecessary FNA biopsy of C-TIRADS and the detection rate of malignant nodules were higher than those of ACR TI-RADS,but the differences were not statistically significant(P>0.05).Conclusion:The two guidelines have good diagnostic performance for the differentiation of benign and malignant thyroid nodules.C-TIRADS guideline has higher sensitivity,and the ACR TI-RADS guideline has higher specificity.In subgroup nodules≤1 cm,the diagnostic performance of the C-TIRADS guideline is higher than those of ACR TI-RADS guideline.