不同超声风险分层系统评估甲状腺结节的验证和对比研究  

Verification and comparisons of different ultrasound risk-stratification systems in the evaluation of thyroid nodules

作　　者：蒋丽晴 周平[1] 田双明[1] 刘稳刚[1] 赵永锋[1] 章燕 Jiang Liqing;Zhou Ping;Tian Shuangming;Liu Wengang;Zhao Yongfeng;Zhang Yan(Department of Ultrasound,the Third Xiangya Hospital of Central South University,Changsha 410013, China)

机构地区：[1]中南大学湘雅三医院超声科,长沙410013

出　　处：《中华超声影像学杂志》2018年第12期1048-1053,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81871367).

摘　　要：目的验证和比较Kwak等制定的TI-RADS(Kwak TI-RADS)、2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》(ATA指南分级)、2017年美国放射学院发布的TI-RADS(ACR TI-RADS)、Zhou等制定的TI-RADS(Zhou TI-RADS)在甲状腺结节评估中的价值。方法回顾性分析273例患者共339个甲状腺结节的超声图像,用四种分层系统对甲状腺结节进行分类,以病理学结果为"金标准",构建ROC曲线,比较四种分层系统的临床应用价值。结果Kwak TI-RADS、ATA指南分级、ACR TI-RADS、Zhou TI-RADS不能归类的结节所占的百分比分别为1.2%、17.5%、0及1.2%;ROC曲线下面积(AUC)分别为0.899、0.879、0.876及0.918。Kwak TI-RADS、ATA指南分级、ACR TI-RADS的敏感性高于Zhou TI-RADS(均P<0.05),然而Zhou TI-RADS的特异性最高(均P<0.05)。Kwak TI-RADS、ATA指南分级、ACR TI-RADS、Zhou TI-RADS的准确性两两之间比较差异均无统计学意义(P>0.05)。结论四种甲状腺风险分层系统对甲状腺结节均有良好的风险评估作用,其中Zhou TI-RADS的敏感性相对较低,但Zhou TI-RADS的特异性和AUC最高。此外,ACR TI-RADS能归类的结节最全面,而ATA指南分级不能进行归类的结节最多。Objective To verify and compare the TI-RADS developed by Kwak et al.(Kwak TI-RADS),2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer(ATA Guideline Classification),2017 TI-RADS released by the American College of Radiology(ACR TI-RADS)and TI-RADS developed by Zhou et al.(Zhou TI-RADS)in the evaluation of thyroid nodules.Methods The ultrasound images of 339 thyroid nodules in 273 patients were analyzed by retrospective study.The thyroid nodules were categorized into aforementioned four stratified systems.Based on the pathological findings considered the " gold standard" ,the receiver operating characteristic(ROC)curve was created to compare the clinical application value of aforementioned four stratified systems.Results The percentage of nodules that could not be categorized were 1.2%,17.5%,0 and 1.2% for the Kwak TI-RADS,ATA guidelines,ACR TI-RADS,and Zhou TI-RADS,respectively and the area under the ROC curve(AUC)was 0.899,0.879,0.876,and 0.918,respectively.The sensitivity of Kwak TI-RADS,ATA guidelines classification,and ACR TI-RADS were higher than that of Zhou TI-RADS(all P<0.05),whereas the specificity of Zhou TI-RADS was the highest(all P<0.05).As for the accuracy,no statistically significant differences were observed between any two of Kwak TI-RADS,ATA guidelines,ACR TI-RADS,and Zhou TI-RADS systems(all P>0.05).Conclusions Four thyroid risk stratification systems provide effective risk assessment for thyroid nodules,Zhou TI-RADS has relatively lower sensitivity,but its specificity and AUC value are the highest among the four evaluated systems.In addition,ACR TI-RADS can classify the most nodules,while the number of nodules that can′t be categorized by ATA guideline is maximum.

关 键 词：超声检查 甲状腺结节 超声风险分层系统 ROC曲线 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]