摘要
目的比较美国放射学会甲状腺影像报告与数据系统(ACR-TIRADS)与欧洲甲状腺影像报告与数据系统(EU-TIRADS)指南对甲状腺良、恶性结节的诊断价值及其细针穿刺细胞学(FNA)指征的临床应用价值。资料与方法回顾性分析经FNA或手术病理证实的582例患者661个甲状腺结节,其中良性结节304个,恶性结节357个。所有结节进行ACR-TIRADS及EUTIRADS分类。通过构建受试者工作特征曲线,比较ACR-TIRADS及EU-TIRADS对甲状腺结节的诊断效能;比较2个指南中推荐的FNA截断值的临床意义。结果ACR-TIRADS分类的甲状腺结节恶性风险为:2类7.5%(5/66),3类10.4%(7/67),4类39.7%(66/166),5类79.0%(279/353);EU-TIRADS为:3类9.7%(12/124),4类22.9%(19/83),5类73.4%(326/444)。ACR-TIRADS及EU-TIRADS判断甲状腺结节良恶性的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为78.2%、75.7%、77.0%、79.0%、74.7%及91.3%、61.2%、77.4%、73.4%、85.7%。ACR-TIRADS推荐的FNA截断值对甲状腺结节处理的特异度高于EU-TIRADS(58.2%比26.6%,χ^(2)=92.092,P<0.001),而敏感度低于EU-TIRADS(61.9%比95.2%,χ^(2)=113.203,P<0.001)。结论ACR-TIRADS及EU-TIRADS对甲状腺结节均具有较高的诊断效能,ACR-TIRADS的诊断特异度较高,而EU-TIRADS的诊断敏感度较高;两个指南中推荐的FNA截断值具有不同的临床意义。
Purpose To compare the diagnostic value of American college of radiology thyroid imaging reporting and data system(ACRTIRADS)and European thyroid imaging reporting and data system(EU-TIRADS)classification in distinguishing benign thyroid nodes from malignant thyroid nodes,and to evaluate the clinical practice of fine-needle aspiration(FNA).Materials and Methods A total of 582 patients with 661 thyroid nodes were retrospectively selected,dividing into 304 benign thyroid nodes and 357 malignant thyroid nodes based on the ACR-TIRADS and EU-TIRADS classification,respectively.Receiver operating characteristic(ROC)was created to compare the diagnostic value of ACR-TIRADS and EU-TIRADS in patients with thyroid nodes.FNA threshold in clinical application between ACR-TIRADS and EU-TIRADS was compared.Results The risk stratification of ACR-TIRADS classification was divided:category 27.5%(5/66),category 310.4%(7/67),category 439.7%(66/166),and category 579.0%(279/353);and EU-TIRADS classification were presented as:category 39.7%(12/124),category 422.9%(19/83),and category 573.4%(326/444),respectively.The sensitivity,specificity,accuracy,positive and negative predictive value of benign and malignant thyroid nodes based on the ACR-TIRADS and EU-TIRADS classification were 78.2%,75.7%,77.0%,79.0%,74.7%;91.3%,61.2%,77.4%,73.4%,85.7%,respectively.Compared with EU-TIRADS,the FNA threshold of ACR-TIRADS was with dramatically higher specificity(58.2%vs.26.6%,χ^(2)=92.092,P<0.001)and significantly lower sensitivity(61.9%vs.95.2%,χ^(2)=113.203,P<0.001).Conclusion Both ACR-TIRADS and EU-TIRADS are valuable tools for risk stratification of thyroid nodes,with high specificity of ACR-TIRADS and high sensitivity of EU-TIRADS,showing the different clinical significances of the FNA threshold from the two guidelines.
作者
陈夏珊
陈卉品
陈江华
CHEN Xiashan;CHEN Huipin;CHEN Jianghua(Department of Ultrasound,Xiamen University Affiliated Zhongshan Hospital,Xiamen 361004,China)
出处
《中国医学影像学杂志》
CSCD
北大核心
2021年第8期770-775,共6页
Chinese Journal of Medical Imaging
关键词
甲状腺结节
甲状腺肿瘤
甲状腺影像报告与数据系统
敏感性与特异性
病理学
外科
诊断
鉴别
Thyroid nodes
Thyroid neoplasms
Thyroid imaging reporting and data system
Sensitivity and specificity
Pathology,surgical
Diagnosis,differential
