BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS re...BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.展开更多
Objective:To investigate the occurrence of BRAFV600E and RAS mutations in thyroid papillary carcinoma (PTC) and to study their correlation with clinicopathological features of PTC. Methods Relevant information of PTC ...Objective:To investigate the occurrence of BRAFV600E and RAS mutations in thyroid papillary carcinoma (PTC) and to study their correlation with clinicopathological features of PTC. Methods Relevant information of PTC was downloaded and organized from The Cancer Genome Atlas (TCGA) via cBioPortal, then the gene mutation and clinical information of 402 PTC samples were analyzed. The correlation of BRAFV600E and RAS mutations with clinicopathological features and prognosis of PTC were subjected to univariate analysis. Secondly, we use Binary Logistic multivariate analysis to analyze the factors screened above. Results BRAFV600E mutation rate is 48.5% (195/402) and RAS mutation rate is 10.2% (41/402) in 402 cases of PTC. Univariate analysis showed that BRAFV600E mutation has nothing to do with age and sex of the patient. There is a significant correlation among BRAFV600E mutation and lymph node metastasis, extrathyroidal invasion, staging, recurrence, progression and pathological subtypes in PTC. There is no significant correlation among RAS and age, sex, staging, recurrence, progression. There is a significant correlation among RAS and lymph node metastasis, extrathyroidal invasion and pathological subtypes in PTC. Multivariate logistic regression analysis indicated that there is a significant correlation among BRAFV600E mutation and extrathyroidal invasion, pathological subtypes in PTC. There is a significant correlation among RAS and lymph node metastasis, extrathyroidal invasion and pathological subtypes in PTC.ConclusionThe mutation rate of BRAFV600E was significantly higher than that of RAS in PTC. Mutations in BRAFV600E and RAS can be used as predictors of prognosis in PTC.展开更多
目的 评估甲状腺结节超声恶性危险分层中国指南(Chinese-thyroid imaging reporting and data system,C-TIRADS)联合超声造影(contrast-enhancedultrasound,CEUS)评估桥本甲状腺炎4类结节。方法 回顾性分析2022年6月至12月于益阳市中心...目的 评估甲状腺结节超声恶性危险分层中国指南(Chinese-thyroid imaging reporting and data system,C-TIRADS)联合超声造影(contrast-enhancedultrasound,CEUS)评估桥本甲状腺炎4类结节。方法 回顾性分析2022年6月至12月于益阳市中心医院就诊的79例桥本甲状腺炎患者的120个C-TIRADS4类甲状腺结节资料。CEUS检查时如结节表现可疑的1种或多种良/恶性特征,均采取降/升一级的处理,以最终手术病理结果为金标准。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),比较诊断效能。结果 CEUS后再次分级的C-TIRADS诊断甲状腺结节良恶性的敏感度、特异性和准确性分别为93.0%、87.8%和90.8%(P<0.05)。ROC曲线下面积分别为0.811和0.904(P<0.05)。结论 C-TIRADS联合CEUS评估桥本甲状腺炎4类结节具有更好的诊断效能。展开更多
目的了解甲状腺癌分子与细胞生物学领域的研究现状与发展趋势。方法在科学网核心合集(WoSCC)中按照检索条件获取甲状腺癌分子与细胞生物学领域2013年1月1日—2022年12月31日发表的相关文献,利用文献计量软件VOSviewer和Excel进行文献计...目的了解甲状腺癌分子与细胞生物学领域的研究现状与发展趋势。方法在科学网核心合集(WoSCC)中按照检索条件获取甲状腺癌分子与细胞生物学领域2013年1月1日—2022年12月31日发表的相关文献,利用文献计量软件VOSviewer和Excel进行文献计量与可视化分析。结果共纳入文献1627篇,其中2013年发文量为113篇,2022年发文量为214篇,年度发文量总体呈上升趋势。共有9274名作者,其中发文量不低于10篇的有6名。共有2042个机构,其中发文量前10的机构大多是中国的大学。共有68个国家,发文量最大的国家是中国,其次是美国。共有513种期刊,载文量前10的期刊主要是肿瘤学领域期刊,其次是内分泌与代谢领域期刊。共引用了5887种期刊的62563篇文献,共被引次数最高的期刊是《Journal of Biological Chemistry》(1608次),共被引用次数最高的文献是《Molecular pathogenesis and mechanisms of thyroid cancer》(89次)。结论甲状腺癌分子与细胞生物学领域目前正在稳步发展,铁死亡、糖基化、端粒酶逆转录酶以及氧化应激是该领域的研究前沿。展开更多
超声因其安全、无创、低价、方便等优点,成为甲状腺结节检测的首选方法,目前国内外有数个版本甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)用于甲状腺结节恶性风险的分层管理。不同版本TI-RADS对同一...超声因其安全、无创、低价、方便等优点,成为甲状腺结节检测的首选方法,目前国内外有数个版本甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)用于甲状腺结节恶性风险的分层管理。不同版本TI-RADS对同一甲状腺结节的分类及其是否需要进行细针穿刺活检(fine-needle aspiration biospy,FNAB)的建议存在差异。本文对各TI-RADS版本在甲状腺结节风险分层管理方面的应用、优势与局限性,以及其最新的研究进展进行了述评。展开更多
目的:探讨超声人工智能(artificial intelligence,AI)辅助诊断系统在甲状腺结节良恶性诊断中的应用价值。方法:选取2021年11月—2022年2月在汕头大学医学院第二附属医院进行甲状腺常规超声检查的患者217例(428个结节),男性59例,女性158...目的:探讨超声人工智能(artificial intelligence,AI)辅助诊断系统在甲状腺结节良恶性诊断中的应用价值。方法:选取2021年11月—2022年2月在汕头大学医学院第二附属医院进行甲状腺常规超声检查的患者217例(428个结节),男性59例,女性158例,年龄19~75岁,平均(47±13)岁。其中经病理证实的患者77例(162个结节),男性17例,女性60例;年龄19~75岁,平均(47±13)岁。采用美国放射协会的甲状腺影像报告与数据系统评估甲状腺结节的良恶性,以中心阅片专家的结果为标准,比较住院医师联合AI辅助诊断前后评估428个甲状腺结节的准确度。以病理结果为“金标准”,比较住院医师、住院医师+AI、主治医师、中心阅片专家、AI组评估162个结节的敏感度、特异度、准确度和受试者工作特征曲线下面积(area under curve,AUC)。结果:428个甲状腺结节以中心阅片专家的评估结果为标准,住院医师诊断的准确度为88.32%(378/428),联合超声AI诊断系统后准确度提高至94.86%(406/428),差异有统计学意义(χ^(2)=11.89,P=0.001)。162个甲状腺结节以病理结果为金标准,住院医师、主治医师、中心阅片专家、AI组诊断的敏感度分别为43.90%、78.05%、75.61%、75.61%,准确度分别为67.28%、84.57%、85.80%、84.57%。住院医师在超声AI诊断系统的辅助下,诊断的敏感度提高到78.05%,准确度提高到82.72%,与主治医师、中心阅片专家、AI组比较,差异均无统计学意义(P>0.05)。住院医师、住院医师+AI、主治医师、中心阅片专家、AI组的AUC分别为0.596、0.812、0.824、0.816、0.816。住院医师组在超声AI诊断系统的辅助下诊断效能明显提高,与主治医师、中心阅片专家组比较,差异均无统计学意义(P>0.05)。结论:超声AI辅助诊断系统在甲状腺结节良恶性诊断中的具有较高的价值,可以提高住院医师的诊断效能。展开更多
文摘BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
基金National Natural Science Foundation of China.Project No:81302577.
文摘Objective:To investigate the occurrence of BRAFV600E and RAS mutations in thyroid papillary carcinoma (PTC) and to study their correlation with clinicopathological features of PTC. Methods Relevant information of PTC was downloaded and organized from The Cancer Genome Atlas (TCGA) via cBioPortal, then the gene mutation and clinical information of 402 PTC samples were analyzed. The correlation of BRAFV600E and RAS mutations with clinicopathological features and prognosis of PTC were subjected to univariate analysis. Secondly, we use Binary Logistic multivariate analysis to analyze the factors screened above. Results BRAFV600E mutation rate is 48.5% (195/402) and RAS mutation rate is 10.2% (41/402) in 402 cases of PTC. Univariate analysis showed that BRAFV600E mutation has nothing to do with age and sex of the patient. There is a significant correlation among BRAFV600E mutation and lymph node metastasis, extrathyroidal invasion, staging, recurrence, progression and pathological subtypes in PTC. There is no significant correlation among RAS and age, sex, staging, recurrence, progression. There is a significant correlation among RAS and lymph node metastasis, extrathyroidal invasion and pathological subtypes in PTC. Multivariate logistic regression analysis indicated that there is a significant correlation among BRAFV600E mutation and extrathyroidal invasion, pathological subtypes in PTC. There is a significant correlation among RAS and lymph node metastasis, extrathyroidal invasion and pathological subtypes in PTC.ConclusionThe mutation rate of BRAFV600E was significantly higher than that of RAS in PTC. Mutations in BRAFV600E and RAS can be used as predictors of prognosis in PTC.
文摘目的了解甲状腺癌分子与细胞生物学领域的研究现状与发展趋势。方法在科学网核心合集(WoSCC)中按照检索条件获取甲状腺癌分子与细胞生物学领域2013年1月1日—2022年12月31日发表的相关文献,利用文献计量软件VOSviewer和Excel进行文献计量与可视化分析。结果共纳入文献1627篇,其中2013年发文量为113篇,2022年发文量为214篇,年度发文量总体呈上升趋势。共有9274名作者,其中发文量不低于10篇的有6名。共有2042个机构,其中发文量前10的机构大多是中国的大学。共有68个国家,发文量最大的国家是中国,其次是美国。共有513种期刊,载文量前10的期刊主要是肿瘤学领域期刊,其次是内分泌与代谢领域期刊。共引用了5887种期刊的62563篇文献,共被引次数最高的期刊是《Journal of Biological Chemistry》(1608次),共被引用次数最高的文献是《Molecular pathogenesis and mechanisms of thyroid cancer》(89次)。结论甲状腺癌分子与细胞生物学领域目前正在稳步发展,铁死亡、糖基化、端粒酶逆转录酶以及氧化应激是该领域的研究前沿。
文摘超声因其安全、无创、低价、方便等优点,成为甲状腺结节检测的首选方法,目前国内外有数个版本甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)用于甲状腺结节恶性风险的分层管理。不同版本TI-RADS对同一甲状腺结节的分类及其是否需要进行细针穿刺活检(fine-needle aspiration biospy,FNAB)的建议存在差异。本文对各TI-RADS版本在甲状腺结节风险分层管理方面的应用、优势与局限性,以及其最新的研究进展进行了述评。
文摘目的:探讨超声人工智能(artificial intelligence,AI)辅助诊断系统在甲状腺结节良恶性诊断中的应用价值。方法:选取2021年11月—2022年2月在汕头大学医学院第二附属医院进行甲状腺常规超声检查的患者217例(428个结节),男性59例,女性158例,年龄19~75岁,平均(47±13)岁。其中经病理证实的患者77例(162个结节),男性17例,女性60例;年龄19~75岁,平均(47±13)岁。采用美国放射协会的甲状腺影像报告与数据系统评估甲状腺结节的良恶性,以中心阅片专家的结果为标准,比较住院医师联合AI辅助诊断前后评估428个甲状腺结节的准确度。以病理结果为“金标准”,比较住院医师、住院医师+AI、主治医师、中心阅片专家、AI组评估162个结节的敏感度、特异度、准确度和受试者工作特征曲线下面积(area under curve,AUC)。结果:428个甲状腺结节以中心阅片专家的评估结果为标准,住院医师诊断的准确度为88.32%(378/428),联合超声AI诊断系统后准确度提高至94.86%(406/428),差异有统计学意义(χ^(2)=11.89,P=0.001)。162个甲状腺结节以病理结果为金标准,住院医师、主治医师、中心阅片专家、AI组诊断的敏感度分别为43.90%、78.05%、75.61%、75.61%,准确度分别为67.28%、84.57%、85.80%、84.57%。住院医师在超声AI诊断系统的辅助下,诊断的敏感度提高到78.05%,准确度提高到82.72%,与主治医师、中心阅片专家、AI组比较,差异均无统计学意义(P>0.05)。住院医师、住院医师+AI、主治医师、中心阅片专家、AI组的AUC分别为0.596、0.812、0.824、0.816、0.816。住院医师组在超声AI诊断系统的辅助下诊断效能明显提高,与主治医师、中心阅片专家组比较,差异均无统计学意义(P>0.05)。结论:超声AI辅助诊断系统在甲状腺结节良恶性诊断中的具有较高的价值,可以提高住院医师的诊断效能。
