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: 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 d...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.展开更多
Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for re...Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.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
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supported by grants from the National Natural Science Foundation of China (Grant No. 81261120566)Jiangsu Province Key Medical Personnel Project (Grant No. RC2011068)+2 种基金333 Projects in the Fourth Phase of Jiangsu Province (Grant No. BRA2015389)Jiangsu Province "Six First Project" Research Program (Grant No. LGY2016004)the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘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.
文摘Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.
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。
