2015ATA、2016KTA/KSThR和2017ACR指南超声模式在不确定意义甲状腺结节的应用价值

Diagnostic performance of ultrasound-based risk stratification systems for indeterminate thyroid nodules:comparison of the 2015ATA guidelines with the 2016KTA/KSThR and 2017ACR guidelines

目的:探讨2015ATA、2016KTA/KSThR及2017ACR三种指南模式对性质不明确的甲状腺结节的诊断效能。方法:选取464例经细针穿刺(FNA)细胞学诊断为不明确意义的甲状腺结节患者作为研究对象,分析并比较良恶性结节的临床资料及二维超声特征,对所有结节的二维超声图像分别行2015ATA、2016KTA/KSThR及2017ACR三种指南超声模式分级,计算得出各分级结节的恶性风险,使用受试者工作特征曲线计算得出3种超声模型鉴别不明确意义的良恶性结节的最佳诊断界点,并根据诊断界点得出诊断效能等指标。结果:①在良恶性结节之间,患者的年龄、性别及结节大小差异无统计学意义(P>0.05);不规则边界、微钙化等超声特征对结节良恶性的鉴别差异无统计学意义;②2015ATA超声模式诊断不明确意义的甲状腺结节的敏感性为87.9%,均略低于2016KTA/KSThR和2017ACR指南超声模式,差异无统计学意义(P>0.05)。2015ATA的特异性为63.9%,均明显高于2016KTA/KSThR和2017ACR指南超声模式(P<0.05);其准确性与2016KTA/KSThR指南超声模式相近,差异无统计学意义(P>0.05),但明显高于2017ACR指南超声模式(P<0.05);③2015ATA诊断不明确意义的甲状腺结节的曲线下面积为0.889,略低于2016KTA/KSThR(0.902),差异无统计学意义(P>0.05),但却略高于2017ACR(0.854),差异有统计学意义(P<0.05)。结论:2015ATA指南对不确定意义的甲状腺结节良恶性的诊断具有较高的特异性和准确性以及适度的敏感性,有助于临床有效地评估和管理此类结节。

Objective:To evaluate the diagnostic value of the 2015 ATA,2017 ACR and 2016 KTA/KSThR ultrasound model for indeterminate thyroids nodules Method:Four hundred and sixty-four patients with thyroid nodules that were initially diagnosed as indeterminate thyroids nodules by fine needle aspiration(FNA)cytology were included in this study.The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules.The two-dimensional ultrasound images of all nodules were sorted by the 2015 ATA,2017 ACR and 2016 KTA/KSThR guideline ultrasound model grading criteria,and the malignant risk of different grading were calculated.In order to calculate the diagnosis and other indicators,the optimal threshold drawing from ROC curve was drawn to obtain the cut-off value of 2015 ATA,2017 ACR and 2016 KTA/KSThR.Result:①There was no significant difference in age,sex and nodule size between benign and malignant nodules(P>0.05),and there also was no significant difference in irregular margin,microcalcification between benign and malignant nodules.②The sensitivity of the 2015 ATA ultrasound model was 87.9%,slightly lower than that of the 2016 KTA/KSThR and 2017 ACR guidelines(P>0.05).The specificity of 2015 ATA was 63.9%,which was significantly higher than that of 2016 KTA/KSThR and 2017 ACR guidelines(P<0.05).There was no significant difference between 2015 ATA ultrasound model and 2016 KTA/KSThR guide ultrasound for the accuracy(P>0.05),but the accuracy of 2015 ATA ultrasound model was significantly higher than that of 2017 ACR guide(P<0.05).③The area under the curve of 2015 ATA was slightly lower than that of 2016 KTA/KSThR(0.889 VS0.902,P>0.05)and significantly higher than that of 2017 ACR(0.889 VS 0.854,P<0.05).Conclusion:2015 ATA has high specificity and accuracy and moderate sensitivity for the diagnosis of benign and malignant indeterminate thyroids nodules,which is helpful for the clinical evaluation and management of such nodules.