2017版甲状腺影像报告和数据系统诊断甲状腺良恶性结节的价值

Value of 2017thyroid imaging reporting and data system in diagnosis of benign and malignant thyroid nodules

目的探讨2017版美国放射学院甲状腺影像报告和数据系统(TI-RADS)在评估甲状腺良恶性结节中的价值。方法采用2017版TI-RADS分类诊断标准,回顾性分析1 039例患者共1 109个甲状腺结节的声像图特征;以粗针穿刺活检或手术病理学结果为金标准,评价2017版TI-RADS对不同类别结节的诊断效能。结果良性结节551个,恶性结节558个;良恶性结节的成分、回声类型、纵横比、边界、有无钙化差异均有统计学意义(P均<0.05)。TI-RADS 2～5类结节中,恶性率分别为0、5.45%(3/55)、22.29%(39/175)和58.84%(516/877),差异有统计学意义(P<0.001)。以TI-RADS分类≥4为标准,诊断甲状腺恶性结节的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为99.46%(555/558)、9.80%(54/551)、54.91%(609/1 109)、52.76%(555/1 052)和94.74%(54/57)。结论根据2017版TI-RADS分类评估恶性甲状腺结节具有临床应用价值,但特异度较低,分类标准尚需进一步完善。

Objective To explore the value of 2017 thyroid imaging reporting and data system(TI-RADS)suggested by American College of Radiology in diagnosis of benign and malignant thyroid nodules.Methods According to 2017 TIRADS,the sonographic features of 1 109 pathologically diagnosed thyroid nodules in 1 039 patients were retrospectively analyzed.Taken coarse needle biopsy or surgical pathology as the gold standards,the diagnostic efficacy of 2017 TI-RADS for different types of nodules was analyzed.Results Of 1 109 nodules,551 were benign and 558 were malignant.The composition,echogenicity,aspect ratio,boundary and calcification were statistically different between benign and malignant nodules(all P<0.05).The probability of malignancy in nodules with a classification of TI-RADS 2,3,4 and 5 was 0,5.45%(3/55),22.29%(39/175)and 58.84%(516/877),respectively,which had statistical difference(P<0.001).When TI-RADS classification were larger than 4,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 99.46%(555/558),9.80%(54/551),54.91%(609/1 109),52.76%(555/1 052)and 94.74%(54/57),respectively.Conclusion 2017 TI-RADS classification is based on the morphology and maximum diameter management of thyroid nodules,demonstrating clinical application value in evaluating malignant nodules,but the specificity is low,therefore needing further improvement.