2015ATA超声模式与TI-RADS在甲状腺结节定性诊断中的应用  

Value of TI-RADS and the 2015 ATA in qualitative diagnosis of thyroid nodules

作　　者：李小娟[1] 温德惠[1] 张利英 李朝喜[1] 王月红 武宇宏[2] LI Xiaojuan;WEN Dehui;ZHANG Liying;LI Chaoxi;WANG Yuehong;WU Yuhong(Department of Ultrosonography,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Otolarygology Head and Neck Surgery,First Affiliated Hospital of Hebei North University)

机构地区：[1]河北北方学院附属第一医院超声医学科,张家口075000 [2]河北北方学院附属第一医院头颈外科

出　　处：《山西医科大学学报》2018年第9期1078-1082,共5页Journal of Shanxi Medical University

基　　金：河北省张家口市科技局指令性计划(1621031D)

摘　　要：目的分析2015年美国甲状腺学会(American Thyroid Association,ATA)成人甲状腺结节与分化型甲状腺癌分层诊断指南(2015 ATA)与甲状腺影像报告和数据系统(TI-RADS)在甲状腺结节良恶性鉴别诊断中的应用价值。方法回顾性分析2015-12~2016-11河北北方学院附属第一医院收治的甲状腺结节患者425例共483个甲状腺结节术前超声检查资料。分别采用2015 ATA和TI-RADS分级标准,根据术前超声资料,对每个结节进行分级,以组织病理或细胞学为金标准,构建ROC曲线比较两种方法的诊断效能。结果根据2015 ATA分级标准,极低度、低度、中度、高度可疑恶性率分别为1.8%,18.8%,37.8%,87.5%;TI-RADS 1级、2级、3级、4级和5级的可疑恶性率分别为6.2%,22.8%,33.3%,87.0%,93.9%;2015 ATA模式的敏感度高于TI-RADS(97.6%vs 85.0%,P<0.001),而TI-RADS的特异度、准确率、阳性预测值高于2015ATA(P<0.001);2015 ATA未明确的结节类型恶性率为22.2%。结论两种分类标准对甲状腺结节良恶性的鉴别诊断均具有良好的指导作用,但2015ATA标准较TI-RADS敏感性较高,且更加简易,更适用于临床,2015ATA标准未明确提及的结节类型的恶性率较高,应引起临床重视。Objective To analyze the application value of 2015 American Thyroid Association（ATA） management guidelines and the thyroid imaging reporting and data system（TI-RADS） in the differential diagnosis of benign and malignant thyroid nodule.Methods The ultrosonographic results of 483 thyroid nodules in 425 patients from December 2016 to November 2017 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed. All of thyroid nodules were categorized based on 2015 ATA and TI-RADS classification according to preoperative ultrasound data, and receiver operating characteristic curve（ROC） was performed to assess the diagnostic efficacy of the ATA and TI-RADS with FNAC or histopathologic as golden standard.Results According to the 2015 ATA classification standard, the extremely low, low, moderate and highly suspicious malignant rates were 1.8% , 18.8% , 37.8% and 87.5% , respectively. The suspicious malignancy rates of grade 1, grade 2, grade 3, grade 4 and grade 5 were 6.2% , 22.8% , 33.3% , 87.0% and 93.9% according to TI-RADS, respectively. The sensitivity of 2015 ATA model was higher than that of TI-RADS （97.6% vs 85.0% , P 〈0.001）, while the specificity, accuracy and positive predictive value of TI-RADS were higher than those of 2015 ATA（ P 〈0.001）. The malignancy rate of undefined nodule was 22.2% .Conclusion Both TI-RADS and 2015 ATA guidelines have a good guiding role in the differential diagnosis of benign and malignant thyroid nodules. The sensitivity of 2015ATA standard is higher than that of TI-RADS, and 2015ATA standard is simpler and more suitable for clinical use than TI-RADS. The malignant rate of nodule type not explicitly mentioned in the 2015ATA standard is high, which should be paid attention to.

关 键 词：2015年美国甲状腺学会指南 甲状腺超声恶性风险分层 甲状腺影像报告和数据系统 甲状腺结节 诊断 

分 类 号：R445[医药卫生—影像医学与核医学]