中国版甲状腺影像报告和数据系统(C-TIRADS)联合结节内部及周围腺体硬度鉴别甲状腺良、恶性结节

Chinese thyroid imaging reporting and data system(C-TIRADS)combined with intranodular and perinodular stiffness for distinguishing benign and malignant thyroid nodules

目的评估中国版甲状腺影像报告和数据系统(C-TIRADS)联合结节内部及周围腺体硬度鉴别甲状腺良、恶性结节的价值。方法回顾性分析117例经细针抽吸细胞学检查(FNAC)和/或手术病理确诊甲状腺结节患者的常规超声及超声剪切波弹性成像(SWE)资料,按照C-TIRADS对结节进行分类;基于SWE技术测量结节及其周围2 mm腺体的SWE参数,包括甲状腺结节(E)及结节周围腺体(Eshell)杨氏模量值[最大值(E_(max)/Eshell_(max))、平均值(E_(mean)/Eshell_(mean))、最小值(E min/Eshell min)及标准差(E_(SD)/E_(shell SD))]。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估C-TIRADS、SWE及二者联合鉴别甲状腺良、恶性结节的效能。结果共纳入117例共117个甲状腺结节,包括良性结节50个、恶性结节67个。甲状腺恶性结节各SWE参数均高于良性结节(P均<0.001)。C-TIRADS鉴别甲状腺良、恶性结节的AUC为0.736,敏感度为79.10%、特异度为68.00%、准确率为74.36%;E_(max)、E_(mean)、E min及E_(SD)的AUC分别是0.816、0.752、0.664及0.705,以E_(max)的AUC最高;Eshell_(max)、Eshell_(mean)、Eshell min及E_(shell SD)的AUC分别为0.834、0.804、0.693及0.697,以Eshell_(max)的AUC最高,而与E_(max)差异无统计学意义(Z=1.044,P=0.297)。C-TIRADS+E_(max)和C-TIRADS+Eshell_(max)的AUC分别为0.835和0.843,其间差异无统计学意义(Z=0.574,P=0.566)但均高于C-TIRADS(AUC=0.736,Z=2.510、2.230,P均<0.05),二者诊断特异度及准确率均高于C-TIRADS(P均<0.05)。结论C-TIRADS联合结节内部及其周围腺体硬度可有效鉴别良、恶性甲状腺结节,显著提高C-TIRDAS诊断效能。

Objective To explore the value of Chinese thyroid imaging reporting and data system(C-TIRADS)combined with intranodular and perinodular stiffness for distinguishing benign and malignant thyroid nodules.Methods Data of routine ultrasound and ultrasonic shear wave elastography(SWE)in 117 patients with thyroid nodules confirmed by fine needle aspiration cytology(FNAC)and/or surgical pathology were retrospectively analyzed.The nodules were classified according to C-TIRADS and SWE parameters of nodules and surrounding 2 mm glands measured with SWE technique,including Young's modulus of thyroid nodules(E)and perinodular glandular(Eshell)(the_(max)imum[E_(max)/Eshell_(max)],the_(mean)[E_(mean)/Eshell_(mean)]and the minimum[E min/Eshell min]as well as standard deviation[E_(SD)/E_(shell SD)]values).Then receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was calculated to assess the efficacy of C-TIRADS,SWE and the combination for differentiating benign and malignant thyroid nodules.Results Totally 117 thyroid nodules of 117 patients were enrolled,including 50 benign and 67 malignant ones.SWE parameters of malignant thyroid nodules were higher than those of benign ones(all P<0.001).AUC of C-TIRADS for differentiating benign and malignant thyroid nodules was 0.736,with sensitivity of 79.10%,specificity of 68.00%and accuracy of 74.36%.AUC of E_(max),E_(mean),E min and E_(SD) was 0.816,0.752,0.664 and 0.705,respectively,of E_(max)was the highest.AUC of Eshell_(max),Eshell_(mean),Eshell min and E_(shell SD) was 0.834,0.804,0.693 and 0.697,respectively,of Eshell_(max)was the highest,which was not statistically difference with that of E_(max)(Z=1.044,P=0.297).AUC of C-TIRADS+E_(max)and C-TIRADS+Eshell_(max)was 0.835 and 0.843,respectively,being not significantly different(Z=0.574,P=0.566)but higher than that of C-TIRADS(AUC=0.736,Z=2.510,2.230,both P<0.05),with diagnostic specificity and accuracy both higher than those of C-TIRADS(all P<0.05).Conclusion C-TIRADS combined with intranodular and perinodular stiffness could be used to effectively distinguish benign and malignant thyroid nodules,which might improve diagnostic efficiency of C-TIRDAS.