三种TI-RADS系统在甲状腺髓样癌诊断中的比较与评价

Comparison and evaluation of three thyroid imaging reporting and data systems for medullary thyroid carcinoma

目的探讨不同甲状腺影像报告与数据系统(thyroid imaging reporting and data system,TI-RADS)对甲状腺髓样癌(medullary thyroid carcinoma,MTC)的诊断效能。方法纳入2011年8月至2022年8月郑州大学第一附属医院超声科行超声检查并经术后病理确诊为MTC的甲状腺结节160个,随机抽取同时期160个甲状腺乳头状癌(papillary thyroid carcinoma,PTC)及160个良性结节作为对照。分析各组间性别、年龄、结节直径及各超声征象的差异。并分别依据美国放射学学会(American College of Radiology,ACR)TI-RADS、人工智能(artificial intelligence,AI)TI-RADS及中国版TI-RADS(C TI-RADS)对其分类,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)计算诊断价值。应用Kendall协调系数评价各TI-RADS系统的观察者间一致性。结果三组间性别差异无统计学意义(χ2=1.17,P=0.558),但年龄、结节直径差异有统计学意义(F=12.08、40.12,P均<0.001)。ACR、AI及C TI-RADS诊断MTC与良性结节的ROC曲线下面积分别为:0.762、0.773、0.761,差异无统计学意义(Z=1.33、0.01、0.87,P=0.183、0.994、0.386)。但C TI-RADS的敏感性为87.5%,低于ACR TI-RADS及AI TI-RADS(均为95.0%)(P=0.018)。结合穿刺阈值后,C TI-RADS的漏诊率为30.6%,低于ACR TI-RADS的41.3%(P=0.048)及AI TI-RADS的43.1%(P=0.020)。C TI-RADS的医师间诊断一致性为0.884,优于ACR TI-RADS的0.819(P<0.001)及AI TI-RADS的0.839(P<0.001)。结论AI TI-RADS及ACR TI-RADS诊断MTC敏感性更高,C TI-RADS诊断漏诊率更低。AI TI-RADS与ACR TI-RADS诊断效能相似,可取代ACR TI-RADS。

ObjectiveTo investigate the diagnostic performance of different thyroid imaging reporting and data systems(TI-RADS)in the diagnosis of medullary thyroid carcinoma(MTC).MethodsA total of 160 thyroid nodules diagnosed as MTC by postoperative pathology from Aug.2011 to Aug.2022 at the First Affiliated Hospital of Zhengzhou University were included.Additionally,160 papillary thyroid carcinomas(PTC)and 160 benign nodules were randomly selected as controls during the same period.Differences in gender,age,nodule diameter and various ultrasound features were observed.The nodules were classified according to American College of Radiology(ACR)TI-RADS,artificial intelligence(AI)TI-RADS and Chinese(C TI-RADS).Then,receiver operating characteristic curve(ROC)were plotted to calculate the diagnostic value.The Kendall concordance coefficient was used to evaluate the interobserver consistency of each TI-RADS system.ResultsThere was no statistically significant difference in gender among the three groups(χ2=1.17,P=0.558).However,significant differences were observed in age and nodule diameter(F=12.08,40.12,P<0.001 for both).The area under ROC(AUC)for diagnosing MTC and benign nodules using ACR,AI,and C-TIRADS were 0.762,0.773,and 0.761,respectively,with no statistically significant differences(Z=1.33,0.01,0.87,P=0.183,0.994,0.386).However,the sensitivity of C TI-RADS(87.5%)was lower than that of ACR and AI TI-RADS(both 95.0%)(P=0.018).After combining the biopsy threshold,the false negative rate of C-TIRADS was lower than that of ACR(30.6%vs.41.3%)(P=0.048)and AI TIRADS(30.6%vs.43.1%)(P=0.020).The inter-observer diagnostic consistency of C-TIRADS was superior to ACR(0.884 vs.0.819,P<0.001)and AI TIRADS(0.884 vs.0.839)(P<0.001).ConclusionsAI and ACR TI-RADS have higher sensitivity in diagnosing MTC,while C TI-RADS has a lower puncture missed diagnosis rate.AI has similar diagnostic performance to ACR TI-RADS and can replace ACR TI-RADS.