TIRADS与2015年美国甲状腺学会指南超声模式对甲状腺结节良恶性鉴别诊断效能的对比研究  

Comparison of diagnostic value between TIRADS and ultrasound patterns of ATA （2015） guidelines in the differentiation of benign and malignant thyroid nodule

作　　者：徐婷[1] 顾经宇[1] 叶新华[2] 徐书航 吴阳[4] 邵新宇[5] 高远[6] 刘德珍[7] 陆卫平[7] 华飞[4] 施毕旻[5] 梁军[8] 许岚[9] 唐伟[6] 刘超[3] 武晓泓[1] Xu Ting Gu Jingyu Ye Xinhua Xu Shuhang Wu Yang Shao Xinyu Gao Yuan Liu Dezhen Lu Weiping Hua Fei Shi Bimin Liang Jun Xu Lan Tang Wei Liu Chao Wu Xiaohong(Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院内分泌科,210029 [2]南京医科大学第一附属医院超声诊断科,210029 [3]江苏省中西医结合医院内分泌科 [4]常州市第一人民医院内分泌科 [5]苏州大学附属第一医院内分泌科 [6]江阴市人民医院内分泌科 [7]淮安市第一人民医院内分泌科 [8]徐州市中心医院内分泌科 [9]无锡市人民医院内分泌科

出　　处：《中华内分泌代谢杂志》2016年第12期999-1002,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：比较甲状腺影像报告和数据系统（TIRADS）与2015年美国甲状腺学会（ATA）指南这2种超声模型在甲状腺结节良恶性病变鉴别诊断中的价值。选取江苏地区7个城市8家三级甲等医院至内分泌科门诊行甲状腺细针穿刺活检或甲状腺外科住院行手术切除的639例甲状腺结节患者病例。根据术前高分辨超声图像对结节进行TIRADS及ATA（2015）分级。构建受试者工作特征曲线比较2种模型的诊断价值。结果：（1）纳入639例患者，847例结节。男性129例，女性510例，平均年龄（46.77±12.98）岁。（2）818例结节有TIRADS分级结果。TIRADS 2、3、4A、4B、5的恶性比例分别为0、15.9%、49.1%、78.8%、100%。（3）793例结节可行ATA分级。极低度、低度、中度、高度可疑恶性的恶性风险分别为6.2%、10.3%、24.9%、70.1%。（4）ATA指南的特异性显著高于TIRADS分级（77.9%对70.1%, P＝0.001），而两者受试者工作特征曲线下面积、敏感性差异无统计学意义（P＝0.447、P＝0.099）。在甲状腺结节良恶性病变的超声鉴别诊断中，TIRADS具有较高的敏感性和曲线下面积，而ATA（2015）指南超声模式的特异性较高。To compare the diagnostic value between the thyroid imaging reporting and data system （TIRADS） and ultrasound （US） patterns of 2015 American Thyroid Association （ATA） guidelines in the differentiation of benign and malignant thyroid nodules. 639 patients in Jiangsu province who were scheduled for uhrasound-guided fine-needle aspiration biopsy or thyroidectomy were recruited for the retrospective study. All of them were categorized based on TIRADS and ultrasound patterns of ATA （ 2015 ） guidelines. The receiver operating characteristic curve was established to assess and compare the diagnostic value of the two models. Results ： （ 1 ） 639 patients with 847 thyroid nodules were included in this study, 510 females and 129 males. The mean age was （46.77 ＋ 12.98 ） years old. （ 2 ） 818 nodules could be classified according to TIRADS. The malignancy rates of TIRADS 2,3, 4A, 4B, 5 were 0, 15.9%, 49.1%, 78.8% , and 100% , respectively. （3） Ultrasound patterns of ATA could be assigned to 793 nodules. The malignancy rates of nodules with very low, low, intermediate, high suspicion for malignancy were 6.2% , 10.3% , 24.9% and 70.1% , respectively. （4） Ultrasound patterns of ATA had higher specificity （77.9%） compared to TIRADS. The sensitivity and area under curve of ultrasound patterns of ATA were lower than those of TIRADS, though, not significant. Ultrasound patterns of ATA（2015） guidelines may yield higher specificity in the differential diagnosis of benign and malignant thyroid nodules, while TIRADS classification may offer a relatively higher sensitivity and area under curve.

关 键 词：甲状腺结节 甲状腺影像报告和数据系统 超声模式 2015美国甲状腺学会指南 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学] R581[医药卫生—临床医学]