不同甲状腺超声报告系统对桥本甲状腺炎患者结节的评估比较

目的探讨三种经典的不同甲状腺超声报告系统--2015年美国甲状腺协会(ATA)指南、2016年韩国甲状腺放射学会(KSThR)指南和2017年美国放射学会(ACR)指南分别对桥本甲状腺炎(HT)背景下甲状腺结节的诊断性能及非必要超声引导下细针穿刺活检(US-FNA)率。方法收集841例患者共853个结节,筛选后最终纳入126例患者135个结节。由两名经验丰富的超声诊断医生在对患者临床诊断和病理结果不知情的情况下对所有甲状腺结节图像进行回顾性分析,并分别参照ATA、ACR和KSThR三种超声报告系统对其恶性风险进行分类。以最终病理为诊断标准,比较三种不同指南对甲状腺结节的诊断性能和不必要的细针穿刺活检(FNA)发生率。结果135个结节最终病理证实恶性结节97个,良性结节38个。良性结节组年龄大于恶性结节,性别无差异,甲状腺实验室指标无明显差异。135个甲状腺结节中,参照ATA指南、ACR指南得出良性到高度怀疑恶性百分比,除“中度怀疑”类别高于建议风险外,其余类别均在建议风险范围内。而参照KSThR指南结果显示,从良性到高度怀疑恶性百分比,计算出的所有类别恶性风险几乎都在建议的范围内。若将高度怀疑作为鉴别肿瘤良性和恶性的截断值,进一步比较了三种指南的诊断性能,结果显示ACR指南的敏感性和阴性预测值最低,但特异性和阳性预测值最高。根据ATA、ACR和KSThR指南的FNA建议标准,其各自的非必要FNA分别为20%、12.6%和21.5%。结论三种指南对HT背景下甲状腺结节的评估中,ACR尽管敏感性最低,但特异性最高,并且具有最低的非必要FNA率,值得临床推广应用。

Objective To explore the diagnostic performance and unnecessary ultrasound-guided fine-needle aspiration(US-FNA)rate of three different classic thyroid ultrasound reporting systems-the 2015 American Thyroid Association(ATA)guidelines,the 2016 Korean Society of Thyroid Radiology(KSThR)guidelines,and the 2017 American College of Radiology(ACR)guidelines for thyroid nodules in the background of Hashimoto's thyroiditis(HT).Methods A total of 841 patients with 853 nodules were collected,and 126 patients with 135 nodules were ultimately included after screening.Two experienced ultrasound physicians who were blind to the patient's clinical diagnosis and pathological results and retrospective analyzed all the thyroid nodule images,and classified their malignant risk based on ATA,ACR,and KSThR3 ultrasound reporting systems,respectively.Based on the final pathology results,compared the diagnostic performance and the incidence of unnecessary FNA of the three different guidelines for thyroid nodules.Result 97 malignant nodules and 38 benign nodules were confirmed.The age of the benign nodule group was older than that of the malignant nodule group,and there were no differences in gender or thyroid laboratory indicators.Using highly suspicious as the cutoff value for distinguishing benign from malignant tumors,the diagnostic performance of the three guidelines was further compared,and the results showed that the ACR guidelines had the lowest sensitivity and negative predictive value but the highest specificity and positive predictive value.According to the FNA recommendation standards of the ATA,ACR,and KSThR guidelines,their respective unnecessary FNA rates were 20%,12.6%,and 21.5%respectively.Conclusion In the evaluation of thyroid nodules in the background of HT,although the ACR had the lowest sensitivity,it had the highest specificity and the lowest unnecessary FNA rate among the three guidelines,which is worthy of clinical promotion and application.