摘要
目的对比研究美国放射学会甲状腺影像报告与数据系统(ACR TI-RADS)与美国甲状腺协会(ATA)超声风险分类系统评估甲状腺良恶性结节的临床应用价值。方法回顾性分析经手术或细针穿刺细胞学证实的518个甲状腺良恶性结节资料,在对比分析甲状腺良恶性结节的超声图像特征的基础上,分别对比两种超声风险分类系统在不同诊断界点上的诊断准确度,绘制受试者工作特征(ROC)曲线,研究二者的一致性。结果甲状腺恶性结节的超声图像特征为实性、低回声、纵横比大于1、边缘不规则和点状强回声的发生率显著高于良性结节(P<0.001);随着两种超声风险分类系统分类等级的提高,恶性风险显著增大;诊断效能方面,ACR TI-RADS 5类和ATA超声风险分类系统高度可疑恶性类别对甲状腺恶性结节的诊断准确度最高,两种方法的一致性好(Kappa=0.926),二者的ROC曲线下面积分别为0.926、0.918,差异无统计学意义(P>0.05)。该研究中,ATA超声风险分类系统对20例结节(3.9%)无法进行分类,ACR TI-RADS仅对2例结节(0.4%)无法进行评估,二者差异有统计学意义(P<0.001)。结论两种超声风险分类系统在诊断甲状腺恶性结节中的应用价值相当,与ATA超声风险分类系统相比,ACR TI-RADS更为全面,能够对绝大多数结节进行分类。
Objective To compare the clinical value in the evaluation of benign and malignant thyroid nodules between the American College of Radiology thyroid imaging,reporting and data system(ACR TI-RADS)and the American Thyroid Association(ATA)ultrasound risk classification system.Methods A total of 518 benign and malignant thyroid nodules confirmed by the operation or fine needle aspiration cytology were analyzed retrospectively.Based on the comparative analysis of the ultrasonic image characteristics of benign and malignant thyroid nodules,the diagnostic accuracy of two ultrasonic risk classification systems at different diagnostic boundaries were compared.The receiver operating characteristic(ROC)curve was drawn to study the consistency of both systems.Results The sonographic features of malignant thyroid nodules were solid,hypoechoic,aspect ratio>1,margin irregularly and punctate hyperechoic.The incidence of the above sonographic features of malignant nodules was significantly higher than that of the benign nodules(P<0.001).With the increase of grade,the malignant risk of both systems increased significantly.In terms of diagnostic efficacy,ACR TI-RADS at category 5 and ATA ultrasound risk classification system on highly suspicious malignant nodules had the highest accuracy in the diagnosis of malignant nodules,and the consistency of both methods was very well(Kappa=0.926).Area under the ROC curve of both systems were 0.926 and 0.918 respectively,and there was no statistical difference(P>0.05).In this study,a total of 20 cases(3.9%)could not be evaluated by ATA ultrasound risk classification systems and two cases(0.4%)could not be evaluated by ACR TI-RADS system,and there was a significant difference between the two systems(P<0.001).Conclusion The two ultrasound risk classification systems had equal value in the diagnosis of malignant thyroid nodules.Compared with the ATA ultrasound risk classification systems,the ACR TI-RADS classification system was more comprehensive and could classify the vast majority of nodules.
作者
谢德胜
陈萍
何芸
尚永宁
方可敬
郭燕丽
XIE Desheng;CHEN Ping;HE Yun;SHANG Yongning;FANG Kejing;GUO Yanli(Department of Ultrasound,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)
出处
《重庆医学》
CAS
2021年第24期4187-4192,4199,共7页
Chongqing medicine
基金
第三军医大学第一附属医院重大领域技术创新项目(SWH2016ZDCX4101)。
关键词
甲状腺影像报告和数据系统
美国甲状腺协会
超声
甲状腺结节
thyroid imaging reporting and data system
american thyroid association
ultrasound
thyroid nodules
