摘要
目的:基于美国放射学会甲状腺影像报告和数据系统(ACR TI-RADS)构建甲状腺乳头状癌(PTC)颈中央区淋巴结转移(CLNM)的风险预测模型,并评估其诊断效能。方法:纳入2019年1月—2020年5月确诊为PTC的患者319例,共366枚结节作为建模队列,构建风险预测模型(ATR模型);纳入2020年6—8月的PTC患者105例,共121枚结节作为外部验证队列。计算模型C统计量(C-index)并进行拟合优度检验,对比ATR模型与颈部超声(C-US)、电子计算机断层扫描(CT)的诊断效能。结果:ATR模型为:Y=-3.719+0.765×性别+1.094×病灶数量+0.08×最大径+0.266×ACR评分。在建模队列训练集、测试集及外部验证队列中,模型C-index分别为:0.758(95%CI:0.699~0.817),0.717(95%CI:0.619~0.815)及0.756(95%CI:0.671~0.840)。Hosmer-Lemeshow拟合优度检验表明模型预测率与实际发生率的一致性好(P=0.918,P=0.581,P=0.366)。以≥0.434为诊断截值,模型的诊断效能最高(灵敏度:86.0%,特异度:56.3%,约登指数:0.423),在外部验证队列中,C-US与CT的诊断效能比较,各指标均无明显差异(P>0.05);与C-US、CT检查相比,ATR模型诊断灵敏度(66.1%和16.1%,P<0.001;66.1%和9.7%,P<0.001),符合率(68.6%和55.4%,P=0.041;68.6%和52.9%,P=0.012)均较高,阴性预测值高于CT(66.7%和50.9%,P=0.042),而与C-US无差异(66.7%和52.3%,P=0.066);阳性预测值(70.7%和83.3%,P=0.211;70.7%和85.7%,P=0.319;83.3%和85.7%,P=0.713)三者无明显差异,而模型特异度(71.2%和96.6%,P=0.001;71.2%和98.3%,P<0.001)较低。结论:基于ACR TI-RADS评分所构建的风险预测模型较传统影像学检查可以更准确、敏感地预测CLNM。
Objective:To establish a predictive model for central lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC)based on ACR TI-RADS grades(ATR model)and evaluate its diagnostic efficacy.Methods:A total of 319 patients with PTC diagnosed from January 2019 to May 2020 were included,including 366 nodules were used as the modeling cohort to construct the risk prediction model.A total of 105 PTC patients with 121 nodules from June to August 2020 were included as the external validation cohort.The C-index of the model was calculated and the Hosmer-Lemeshow goodness-of-fit test was performed to compare the diagnostic efficiency of ACR model and those conventional imaging models.Results:The ATR model,Y=-3.719+0.765×gender+1.094×multifocality+0.08×maximum diameter+0.266×ACR TI-RADS score.In the training set,validation set and external validation cohort,the model C-index was 0.758(95%CI:0.699-0.817),0.717(95%CI:0.619-0.815)and 0.756(95%CI:0.671-0.840),respectively.The Hosmer-Lemeshow goodness of fit test showed that the prediction rate of the model was consistent with the actual incidence rate(P=0.918;P=0.581;P=0.366).With≥0.434 as the diagnostic threshold,the model had the highest diagnostic efficacy(sensitivity:86.0%,specificity:56.3%,Youden index:0.423).In the external validation cohort,there was no significant difference between C-US and CT(P>0.05).Compared with C-US and CT,the sensitivity(66.1%vs 16.1%,P<0.001;66.1%vs 9.7%,P<0.001)and accuracy(68.6%vs 55.4%,P=0.041;68.6%vs 52.9%,P=0.012)of ATR model were higher,and the negative predictive value was higher than that of CT(66.7%vs 50.9%,P=0.042),but there was no difference between ATR model and C-US(66.7%vs 52.3%,P=0.066);There was no significant difference among the three positive predictive values(70.7%vs 83.3%,P=0.211;70.7%vs 85.7%,P=0.319;83.3%vs 85.7%,P=0.713),but the specificity of the model was low(71.2%vs 96.6%,P=0.001;71.2%vs 98.3%,P<0.001).Conclusion:The predictive model based on ACR TI-RADS grades can predict CLNM of PTC more accurately and sensiti
作者
陈可悦
吕国荣
沈浩霖
王月桂
王康健
杨舒萍
CHEN Keyue;LV Guorong;SHEN Haolin;WANG Yuegui;WANG Kangjian;YANG Shaping('Department of Ultrasound,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou,363000,China;Department of Clinical Medicine,Quanzhou Medical College)
出处
《临床耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2021年第9期773-778,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
福建省科技创新联合资金项目(No:2017Y9071)。
