摘要
目的：探讨超声甲状腺影像报告和数据系统（TI-RADS）在甲状腺结节定性诊断中的应用价值,以及不同超声医师采用TI-RADS评估甲状腺结节的观察者之间的一致性。方法：回顾性分析经手术病理证实的532例患者共计667个结节的常规超声图像资料。由4个经验丰富的超声科医师分别单独分析图像资料并做TI-RADS分类,评价TI-RADS分类在甲状腺结节定性诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性。采用Kappa检验分析4位医师评价超声图像的一致性。结果：TI-RADS分类总体敏感性、特异性、阴性预测值、准确性分别为94%、79%、97%、81%;4级、5级总体阳性预测值分别为55%和92%。观察者间对甲状腺结节TI-RADS 3类、4B类、5类总体评估的一致性好（Kappa=0.62,95%CI为0.58~0.65）,对TI-RADS 4A类（Kappa=0.57）和4B类（Kappa=0.60）的评估为中度一致。结论：TI-RADS分类标准对鉴别甲状腺结节良恶性有较高的诊断价值,不同医师间对TI-RADS分类描述的变异一致性好,TI-RADS分类的应用为临床医师制定合理的治疗方案具有较高的临床应用价值。
Objective：To explore the diagnostic value of the proposed thyroid imaging reporting and data system（TI-RADS）classification in thyroid nodules,and to investigate interobserver variability among different observers using TI-RADS classification for ultrasound.Method：We reviewed 667 thyroid nodules conventional ultrasound image data from 532 patients who were confimed by Pathological diagnosis.Those ultrasound images were reviewed by 4experienced sonographers who can independently assessed the sonographic characteristics and analyzed according to the TI-RADS classification.It is to assess the diagnostic sensitivity,specificity,positive predictive value（PPV）,negative predictive value（NPV）,and accuracy of the TI-RADS classification.The multirater kappa statistics were used to assess the interobserver agreement among different observers.Result：The overall sensitivity,specificity,negative predictive value（NPV）and Accuracy were 94%,79%,97%and 81%,respectively.Positive predictive values（PPVs）for categories 4and 5were 55% and 92%.There was substantial interobserver agreement for categories 3,4Band 5（Kappa=0.62,95%CI,0.58~0.65）,and was moderate agreement for category 4A（Kappa=0.57）and 4B（Kappa=0.60）.Conclusion：The diagnostic criteria of TI-RADS for differentiating between benign and malignant thyroid nodules have a high diagnostic value.There was substantial interobserver agreement in different experienced sonographers.The TI-RADS diagnostic criteria have a high diagnostic value and has great practical value in making aproper and further treatment plan.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2015年第14期1264-1267,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
