基于简化的甲状腺影像报告和数据系统预测甲状腺癌被膜侵犯

Prediction of Thyroid Cancer Capsule Invasion Based on Simplified Thyroid Imaging Report and Data System

目的通过简化甲状腺影像报告和数据系统(TI-RADS)的赋值过程并提出新的分级系统,探讨简化的TI-RADS(sTIRADS)预测甲状腺癌被膜侵犯的可行性。资料与方法回顾性分析2018年1月—2021年1月首都医科大学附属北京天坛医院749个甲状腺结节的超声声像图,根据病理结果分为良性组230个、恶性组519个。收集两组超声征象,并计算OR值(OR>1赋值1分,OR<1赋值0分),使用受试者工作特征曲线评价sTI-RADS鉴别良、恶性结节的效能;根据手术结果筛选出明确记录与被膜有关系的265例恶性结节并分为有被膜侵犯组67例和无被膜侵犯组198例,对两组患者超声及临床资料进行单因素及Logistic回归分析。结果749例甲状腺结节赋值为0、1、2、3、4、5分对应的恶性率分别为1.52%、7.69%、38.24%、76.00%、90.75%、93.75%;以≥3分作为诊断甲状腺恶性结节的临界值时,敏感度和特异度分别为94.03%和67.39%;sTI-RADS分级为:3级,0分,恶性率<2%;4a级,1分,恶性率2%~10%;4b级,2分,恶性率10%~50%;4c级,3分,恶性率50%~90%;5级,4分或5分,恶性率>90%。有被膜侵犯组和无被膜侵犯组常规超声见被膜受累与sTI-RADS分级差异有统计学意义(χ^(2)/t=12.88、-1.26,P≤0.2);常规超声见被膜受累是甲状腺癌被膜侵犯的独立预测因素(P<0.01),sTI-RADS不是甲状腺癌被膜侵犯的独立预测因素(P=0.80)。结论sTI-RADS在甲状腺良、恶性结节鉴别诊断中具有较高效能,甲状腺癌被膜侵犯组中sTI-RADS分级更高,而常规超声见被膜受累是甲状腺癌被膜侵犯的独立预测因素。

Purpose To simplify the assignment process of thyroid imaging report and data system(TI-RADS)and propose a new grading system,and to explore the feasibility of simplified TI-RADS(sTI-RADS)in predicting the capsule invasion of thyroid cancer.Materials and Methods The ultrasonograms of 749 cases of thyroid nodules were retrospectively analyzed from January 2018 to January 2021 in Beijing Tiantan Hospital,Capital Medical University.According to the pathological results,all patients were divided into 230 cases in benign nodule group and 519 cases in malignant nodule group.The ultrasonic signs of nodules in the two groups were collected and the odds ratio(OR)value was calculated(OR>1,assigned 1 score;OR<1,assigned 0 score).The efficiency of sTI-RADS in differentiating benign and malignant nodules was evaluated by receiver operating characteristic curve.According to the surgical results,265 malignant nodules with clear relationship with capsule were screened and divided into 67 cases with capsule invasion and 198 cases without capsule invasion.The ultrasound and clinical data of the two groups were analyzed by univariate analysis and Logistic regression analysis.Results The evaluation results of 749 thyroid nodules were 0,1,2,3,4 and 5 points,and the corresponding malignant rates were 1.52%,7.69%,38.24%,76.00%,90.75%and 93.75%,respectively.When≥3 points were taken as the cutoff value for the diagnosis of thyroid malignant nodules,the sensitivity and specificity were 94.03%and 67.39%,respectively.The classification of sTI-RADS was as follows:sTI-RADS 3,0 points,malignant rate<2%;sTI-RADS 4a,1 point,malignant rate 2%-10%;sTI-RADS 4b,2 points,malignant rate 10%-50%;sTI-RADS 4c,3 points,malignant rate 50%-90%;sTIRADS 5,4 or 5 points,malignant rate>90%.There was significant difference in capsule involvement and sTI-RADS between the capsule invasion and the non-capsule invasion groups(χ^(2)/t=12.88,-1.26,P≤0.2),respectively.Capsule involvement by conventional ultrasound was an independent predictor of thyroid cancer capsule invasion(P<0.01),and sTI-RADS was not an independent predictor of thyroid cancer capsule invasion(P=0.80).Conclusion sTI-RADS has a high diagnostic efficiency in the differential diagnosis of benign and malignant thyroid nodules.The grade of sTI-RADS of the thyroid cancer capsule invasion group is significantly higher than that of non-capsule invasion group,and the capsule involvement seen by conventional ultrasound is an independent predictor of thyroid cancer capsule invasion.