探讨甲状腺影像报告和数据系统在评估甲状腺结节良恶性中的临床价值  

Exploration on the clinical value of thyroid imaging reporting and data system in diagnosis of benign and malignant thyroid nodules

作　　者：陈梅[1,2] 张克勤[1] 毛锋[2] 

机构地区：[1]同济大学附属同济医院内分泌科,上海200065 [2]浙江省宁波市第一医院超声科,浙江宁波315010

出　　处：《医学影像学杂志》2016年第5期795-798,共4页Journal of Medical Imaging

摘　　要：目的探讨甲状腺影像报告和数据系统（thyroid imaging reporting and data system,TI-RADS）在评估甲状腺良恶性结节中的临床价值,并以此来判断结节的良恶性。方法采用2011年Kwak提出的TI-RADS分类诊断标准,回顾性分析598例患者甲状腺结节（共计866个结节）的超声资料,以组织病理学结果为金标准,采用受试者工作特征（ROC）曲线来确定TI-RADS分类的临界值。根据病灶最大径分为两组：≤1cm组,〉1cm组,比较两组间良恶性差异。结果 866个甲状腺结节中,TI-RADS分类为2-5类者其恶性结节所占百分率分别为2类0%（0/46）、3类1.0%（2/194）、4a类6.8%（10/146）、4b类34.7%（34/98）、4c类87.7%（270/308）和5类100%（74/74）。获得ROC曲线,其曲线下面积为0.947,通过分析,取得最合适诊断临界值为4c类,即TI-RADS分类≥4c类者诊断为恶性,而TI-RADS分类〈4c类者诊断为良性。以TI-RADS分类≥4c类为诊断恶性的标准,其诊断敏感度、特异度及准确度分别为88.2%、92.0%、90.3%。以此标准诊断两组不同大小结节间的良恶性,其差异无统计学意义（P〉0.05）。结论 TI-RADS分类在评估甲状腺良恶性结节中具有重要的临床价值。Objective To explore the application value of thyroid imaging reporting and data system（ TI-RADS） in diagnosis of benign and malignant thyroid nodules. Methods Adopting the Kwak＇s diagnostic criteria of TI-RADS in 2011,we retrospectively analyzed the ultrasonic data of 598（ a total of 866 nodules） patients,who were diagnosed consistent with histopathology as the golden standard,and determined the critical value of TI-RADS classification by means of the receiver-operating characteristic（ ROC） curve. The nodules were divided into two groups： the largest diameter of lesion more than 1 cm or less than 1 cm,and then,the benign and malignant differences were compared between the two groups. Results In 866 thyroid nodules,as the TIRADS classification ranged from 2 to 5 class for malignant nodules,the nodules in class 2 accounted for 0%（ 0 /46）,in class 3for 1%（ 2 /194）,in class 4a for 6. 8%（ 10 /146）,in class 4b for 34. 7%（ 34 /98）,in class 4c for 87. 7%（ 270 /308）,and in class 5 for 100%（ 74 /74）,respectively. From the obtained ROC curves,the area under the curve was 0. 947. The most suitable diagnostic threshold was 4c. Namely,TI-RADS classification more than class 4c indicated a diagnosis of malignant,whereas,TIRADS classification less that class 4c implied a diagnosis of benign. The diagnostic sensitivity,specificity and accuracy were88. 2%,92. 0% and 90. 3%,respectively. There were no statistically significant differences in different sizes between two groups（ P〈0. 05）. Conclusion TI-RADS classification has an important clinical value in the assessment of benign and malignant thyroid nodules.

关 键 词：甲状腺结节 超声检查 甲状腺影像报告和数据系统 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]