甲状腺结节恶性风险分层(指南):ACRTI-RADS与C-TIRADS诊断效能及不同医师使用指南一致性的多中心回顾性比较研究

Risk stratification of malignant thyroid nodules(guidelines):A comparative study of diagnostic efficacy of ACR TI-RADS versus C-TIRADS and consistency of guideline application by different

目的比较使用ACR TI-RADS及C-TIRADS两种指南对甲状腺恶性结节的诊断效能、推荐细针穿刺活栓(FNA)的价值及不同医师应用指南的一致性。方法使用ACR TI-RADS及C-TIRADS分类方法,回顾性分析多中心医院2009年1月至2018年11月直径≥1 cm的3018个甲状腺结节超声图像。以病理结果为“金标准”构建ROC曲线,比较两种指南的诊断效能,分析两种指南ROC曲线下面积(AUC)、敏感度、特异度、Youden指数及准确性、不必要穿刺率、是否推荐FNA的一致性。结果ACR TI-RADS及C-TIRADS的AUC为0.892、0.884;ACR TI-RADS的准确性、敏感度、特异度分别为0.812、0.668、0.926,C-TIRADS分别为0.811、0.735、0.870。ACR TIRADS、C-TIRADS的不必要穿刺率分别为40.2%、31.9%;ACR TI-RADS推荐结节FNA的一致性良好,C-TIRADS推荐结节FNA一致性中等(Fleiss’s Kappa值分别为0.713、0.601)。结论ACR TIRADS诊断效能优于C-TIRADS;ACR TI-RADS具有更高的特异度及AUC,C-TIRADS具有更高的敏感度。C-TIRADS的不必要穿刺率更低;ACR TI-RADS推荐FNA一致性更高。

Objective To compare the diagnostic efficacy of ACR TI-RADS and C-TIRADS for malignant thyroid nodules,the value of recommending fine-needle aspiration biopsy(FNA),and the consistency in the application of the guidelines by physicians.Methods Using the ACR TI-RADS and C-TIRADS classification methods,ultrasography images of 3018 thyroid nodules(size≥1 cm)from January 2009 to November 2018 in 5 hospitals were retrospectively analyzed.The receiver operating characteristics(ROC)curves were constructed using pathological findings as the gold standard to compare the diagnostic efficacy of the two guidelines.Area under the ROC curve(AUC),diagnostic sensitivity,specificity,Youden index and accuracy,and consistency of whether recommending FNA were analyzed to test the clinical applicability of the two guidelines.Results The AUC of ACR TI-RADS and C-TIRADS were 0.892 and 0.884;the accuracy,sensitivity,and specificity of ACR TI-RADS were 0.812,0.668,and 0.926,and of C-TIRADS were 0.811,0.735,and 0.870.The unnecessary puncture rates for ACR TI-RADS and C-TIRADS were 40.2% and 31.9%;the concordance of FNA of the recommended nodes for ACR TI-RADS was good,while C-TIRADS was moderate(Fleiss’s Kappa=0.713 and 0.601).Conclusions ACR TIRADS has better diagnostic efficacy than C-TIRADS.ACR TI-RADS has higher specificity and AUC,and C-TIRADS has higher sensitivity.C-TIRADS has lower unnecessary puncture rate and ACR TI-RADS has higher consistency in recommending FNA.