BRAF^(V600E) vs. TIRADS in predicting papillary thyroid cancers in Bethesda system Ⅰ, Ⅲ, and Ⅴ nodules

Objective: Bethesda System for Reporting Thyroid Cytopathology(BSRTC) categories Ⅰ, Ⅲ, and Ⅴaccount for a significant proportion of fine needle aspiration cytology(FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAF^(V600E) mutation and the Thyroid Imaging Reporting and Data System(TIRADS) classification in differentiating papillary thyroid cancers(PTCs) from benign lesions among BSRTC I, III, and V nodules.Methods: A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAF^(V600E) mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination.Results: In the BSRTC I category, BRAF^(V600E) showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAF^(V600E) were similar to those of TIRADS. In comparison to BRAF^(V600E) alone, the combination of the two methods significantly improved sensitivity(BSRTC Ⅰ:93.6% vs. 67.7%, P < 0.01; BSRTC Ⅲ: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC Ⅰ nodules(93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules(93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules(96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001).Conclusions: BRAF^(V600E) exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC Ⅰ nodules, while the two methods showed similar diagnostic value in BSRTC Ⅲ/Ⅴ nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC Ⅰ, Ⅲ, and Ⅴ nodules.

剪切波弹性成像杨氏模量最大值联合甲状腺影像报告和数据系统对甲状腺小结节诊断价值分析

目的:探讨剪切波弹性成像(SWE)杨氏模量最大值(E_(max))联合超声甲状腺影像报告和数据系统(TIRADS)对甲状腺小结节诊断价值。方法:选取在医院接受超声检查并确诊为甲状腺小结节的155例患者,依据病理结果将其分为良性组(84例)和恶性组(71例)。所有患者均行SWE检查,采用TIRADS进行分级评估,记录SWE的杨氏模量最小值(E_(min))、杨氏模量平均值(E_(mean))以及杨氏模量E_(max)。以病理结果为“金标准”,采用受试者工作特征(ROC)曲线分析SWE的E_(max)、TIRADS对甲状腺小结节的诊断价值。结果:病理结果显示:155例甲状腺小结节患者中有84例(占54.19%)患者的结节为良性,71例(占45.81%)患者的结节为恶性。良性结节中结节性甲状腺肿66例,甲状腺滤泡性病变14例,桥本甲状腺炎3例,亚急性甲状腺炎1例;恶性结节均为甲状腺乳头状癌。良性组与恶性组SWE的E_(min)、E_(mean)和E_(max)比较,差异有统计学意义(t=2.762,t=8.695,t=20.523;P<0.05);两组TIRADS分级(3~4级)比较差异有统计学意义(Z=3.126,P<0.05)。TIRADS评估155例甲状腺小结节患者中有66例患者的结节为恶性结节,89例患者的结节为良性结节,经SWE的E_(max)参数诊断69例患者的结节为恶性结节,86例患者的结节为良性结节,两者联合诊断78例患者的结节为恶性结节,77例患者的结节为良性结节。TIRADS、SWE的E_(max)诊断甲状腺小结节的ROC曲线下面积(AUC)分别为0.857和0.843,特异度分别为79.16%和80.95%,灵敏度分别为69.01%和74.64%,约登指数分别为48.14%和55.59%,阳性预测值分别为74.24%和76.81%,阴性预测值分别为75.28%和79.07%;两者联合诊断的AUC为0.914,特异度为84.52%,灵敏度为91.55%,约登指数为76.07%,阳性预测值为83.33%,阴性预测值为92.21%。结论:与SWE的E_(max)、TIRADS分级单项诊断相比,SWE的E_(max)联合TIRADS能够提高对甲状腺小结节良恶性的诊断效能,为临床诊疗提供参考依据。

三种甲状腺影像报告和数据系统临床应用评估

目的:评估3种甲状腺影像报告和数据系统(TIRADS)的临床应用价值。方法:选取168例患者的257个甲状腺结节,根据美国放射学会(ACR)TIRADS(ACR-TIRADS)、欧洲甲状腺协会(EU)TIRADS(EU-TIRADS)和韩国甲状腺协会(KTA)/韩国甲状腺放射科学会(KSThR)TIRADS(KTA/KSThR-TIRADS)的归类,构建受试者工作特征(ROC)曲线,评价并比较其诊断价值,计算不同风险分层诊断灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果:患者的257个甲状腺结节中有7个结节无法纳入EU-TIRADS进行分类。3种风险分层均随着分类级别提高,恶性率呈增高趋势。ACR-TIRADS、EU-TIRADS和KTA/KSThR-TIRADS的ROC曲线下面积(AUC)分别为0.874、0.855和0.880。ACR-TIRADS与KTA/KSThR-TIRADS间诊断灵敏度无显著性差异,但均大于EU-TIRADS,差异有统计学意义(x^2=0.083,x^2=0.083;P<0.05),EU-TIRADS特异度及准确率高于ACR-TIRADS和KTA/KSThR-TIRADS,差异有统计学意义(xACR-TIRADS2=0.030,x^2=0.010;xKTA/KSThR-TIRADS2=0.033,x^2=0.010,P<0.05)。结论:3种风险分层对于鉴别甲状腺结节良恶性均有临床应用价值,其中ACR-TIRADS和KTA/KSThR-TIRADS灵敏度高,EU-TIRADS特异度及准确率高。

甲状腺彩超及数据系统(TI-RADS)在筛查及诊断甲状腺结节中的应用效果

目的探讨甲状腺彩超及数据系统(TI-RADS)在筛查及诊断甲状腺结节中的应用效果。方法收集2015年1月至2015年12月在我院进行甲状腺彩超检查的12 523例体检人员的临床资料,应用数据系统(TI-RADS)行筛选指导临床建议。参考手术病理结果,回顾性分析随访行甲状腺手术患者的临床资料。结果甲状腺结节男性检出率为33.4%(2 504/7 498),女性检出率为44.8%(2 251/5 025),女性患甲状腺结节比例高于男性(χ~2=146.52,P<0.05)。男性甲状腺结节恶性病变占其总甲状腺结节数的1.0%(25/2 504),高于女性结节恶性率的0.8%(18/2 251),不同性别间结节恶性率差异无统计学意义(χ~2=0.5226,P>0.05)。甲状腺结节发病率随年龄增长而升高(χ~2=231.05,P<0.05)。随访行甲状腺手术者53例中,病理结果证实为良性甲状腺结节10例,包括结节性甲状腺肿2例,甲状腺腺瘤2例,淋巴结细胞性甲状腺炎2例,髓样瘤3例,肉芽肿甲状腺结节1例;病理结果证实为恶性肿瘤43例,其中乳头状瘤30例,滤泡状癌9例,髓样癌3例,透明细胞癌1例。属于高度怀疑恶性的甲状腺结节40例,符合率达到93.0%。结论 TI-RADS及指南对临床筛查及诊断甲状腺结节具有良好的指导作用。

The Role of a Pre-Fine Needle Aspiration Clinic in Improving the Quality of Thyroid Nodule Investigation in Saskatchewan

Background: The Canadian province of Saskatchewan introduced a pre-fine needle aspiration (FNA) clinic to review adherence of referrals for thyroid biopsy based on the guidelines of the American College of Radiology’s (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) scoring system. The intention is to minimize low-yield biopsy rates by improving the quality of thyroid nodule investigation in Saskatchewan through this clinic. TI-RADS is a malignancy risk scoring system for thyroid nodules based on five sonographic characteristics: composition, echogenicity, shape, margin, and echogenic foci (calcium). Recommendations for intervention or clinical follow-up are further determined by the size of the nodule. Methods: Through a retrospective chart review of all thyroid biopsy referrals to the Royal University Hospital (RUH) in Saskatchewan between 22 March 2016 and 17 May 2018, the impact of the multidisciplinary pre-FNA clinic on appropriate thyroid biopsies in Saskatchewan was evaluated. Results: This study evaluated 252 referrals, 203 of which underwent FNA and 23 which received surgical biopsy. TI-RADS scores appended to thyroid biopsy referrals increased upon pre-FNA clinic initiation, yet score quality did not improve. Rates of malignant biopsies were lower than ACR-reporting suggesting inappropriate biopsy of low risk nodules perhaps by overcalling the TI-RADS score. The majority of FNA cytology matched final surgical pathology, with 78% of indeterminate FNAs being malignant, and all non-diagnostic FNAs being benign. Conclusions: The implementation of the pre-FNA clinic reduced the number of thyroid biopsies in Saskatchewan by 11% overall.