2017美国放射学会甲状腺影像报告和数据系统（ACR-TIRADS）对甲状腺结节鉴别诊断的效能评估  

Effectiveness evaluation of the Thyroid Imaging Report and Data System proposed by American RadiologicalSociety （2017） （ACR-TIRADS） for differential diagnosis in thyroid nodules

作　　者：张于芝 徐婷 顾经宇[4] 叶新华[5] 徐书航 吴阳[6] 邵新宇[7] 刘德珍[8] 陆卫平[8] 华飞[6] 施毕旻[7] 梁军[9] 许岚[10] 唐伟[2] 刘超[4] 武晓泓 Zhang Yuzhi;Xu Ting;Gu Jingyu;Ye Xinhua;Xu Shuhang;Wu Yang;Shao Xinyu;Liu Dezhen;Lu Weiping;Hua Fei;Shi Bimin;Liang Jun;Xu Lan;Tang Wei;Liu Chao;Wu Xiaohong(Department of Ultrasound, Affiliated Hospital of Integration Chinese and Western Medicine with Nanjing University of Traditional Chinese Medicine, Nanjing 210028, China)

机构地区：[1]南京中医药大学附属中西医结合医院超声科,210028 [2]南京中医药大学附属中西医结合医院内分泌科,210028 [3]江苏省省级机关医院内分泌科 [4]南京医科大学第一附属医院内分泌科 [5]南京医科大学第一附属医院超声科 [6]常州市第一人民医院内分泌科 [7]苏州大学附属第一医院内分泌科 [8]淮安市第一人民医院内分泌科 [9]徐州市中心医院内分泌科 [10]无锡市人民医院内分泌科

出　　处：《中华超声影像学杂志》2018年第6期505-509,共5页Chinese Journal of Ultrasonography

摘　　要：目的评估美国放射学会提出的甲状腺影像报告和数据系统（ACR-TIRADS）对甲状腺结节的鉴别诊断价值，并与Kwak等提出的TIRADS（K-TIRADS）、2015年美国甲状腺学会（AmericanThyroidAssociation，ATA）提出的恶性风险分层系统（ATA风险分层）比较。方法回顾性分析来自江苏地区8家医院的1760例患者的1912个甲状腺结节资料，根据术前超声图像对结节分别进行风险分层，构建ROC曲线评价并比较其诊断价值。结果ACR-TIRADS的ROC曲线下面积（AUC）为0．830，敏感性、阴性预测值分别达86．9％、87．5％，但特异性及阳性预测值较低（64．1%、62．9％）。K-TIRADS的AUC、敏感性及特异性分别高达0．866、84．9％、76．1％。ATA风险分层AUC为0．852，其特异性高达83．4％，但敏感性较低（79．4％）。三种超声风险分层系统之间AUC差异均有统计学意义，其中K-TIRADS最高（Pd0．05）。ACR-TIRADS与K-TIRADS敏感性差异无统计学意义（P=0．137），但均高于ATA风险分层（P〈0．001）。三者之间特异性差异均有统计学意义（P〈0．001），其中ATA风险分层最高。另外，有109个（5．7％）结节无法根据ATA风险分层进行分类，其中恶性率为31．2％。结论ACR-TIRADS整体诊断效率良好，但低于K-TIRADS及ATA风险分层。ACR-TIRADS具有最高的敏感性，ATA风险分层具有最高的特异性，而K-TIRADS整体诊断效能最佳。Objective To evaluate the effect of the Thyroid Imaging Report and Data System proposed by American Radiological Society （ACR-TIRADS） for differential diagnosis in thyroid nodules, and compare ACR-TIRADS to the TIRADS proposed by Kwak et al. （K-TIRADS） and the ultrasound-based risk stratification system evaluated by American Thyroid Association （ATA-Risk Stratification）. Methods The clinical data of 1 760 patients with 1 912 thyroid nodules from 8 hospitals in Jiangsu province were retrospectively analysed. All of them were categorized based on ultrasound-based risk stratification systems. The ROC curve was established to assess and compare the diagnostic value of the systems. Results The area under the ROC curve （AUC） of ACR-TIRADS was 0.830, with high sensitivity and negative predictive value （86.9% and 87.5%, respectively）, and relatively low specificity and positive predictivevalue （64.1% and 62.9%, respectively）. The sensitivity and specificity of K-TIRADS were up to 84.90% and 76.1 %, respectively. The AUC of ATA-Risk Stratification was 0. 852, with relatively high specificity （83.4%）,and low sensitivity （79.4%）. There were significant differences in the AUC among the three ultrasound based risk stratification systems, of which K TIRADS was the highest （ P〈0. 001 ）. There was no significant difference in sensitivity of ACR-TIRADS and K-TIRADS （ P = 0. 137）, but significantly higher than that of ATA Risk Stratification （P 〈 0.001 ）. There were significant differences in the specificity among the three systems, of which ATA-Risk Stratification was the highest （ P 〈0.01 ）. In addition, there were 109 nodules （5.70%） couldn＇t be classified based on ATA Risk Stratification, with high malignancy rate of 31.2 %. Conclusions The diagnostic efficiency of ACR-TIRADS is good, but lower than K-TIRADS and ATA-Risk Stratification. ACR-TIRADS has the highest sensitivity, and ATA Risk Stratification has the highest specificity, while the overall diagnostic efficie

关 键 词：超声检查 甲状腺结节 甲状腺影像报告和数据系统 超声恶性风险分层 鉴别诊断 

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]