Kwak与ACR(2017)甲状腺影像报告和数据系统(TI-RADS)分类的诊断效能比较——多中心回顾性研究  

Efficiency comparison of Kwak and ACR (2017) Thyroid Imaging Reporting and Data System(TI-RADS) classification: a polycentric retrospective study

作　　者：梁羽[1] 岳林先[1] 陈琴[1] 林洁[2] 郭道宁[2] 贺鹏[3] 杨芳[3] 岳文胜[3] 郑红[4] 阮佳泉 刘海军[6] 宋建琼[7] 杨玲英 王娟[9] 周成庭 吴雨恬 王思逸 唐艳琼[13] 袁孟霞 赵岩 Liang Yu;Yue Linxian;Chen Qin;Lin Jie;Guo Daoning;He Peng;Yang Fang;Yue Wensheng;Zheng Hong;Ruan Jiaquan;Liu Haijun;Song Jianqiong;Yang Lingying;Wang Juan;Zhou Chengting;Wu Yutian;Wang Siyi;Tang Yanqiong;Yuan Mengxia;Zhao Yan(Department of Ultrasound, Sichuan Provincial People′s Hospital, Chengdu 610072, China;Department of Ultrasound, First People′s Hospital of Chengdu, Chengdu 610000, China;Department of Ultrasound, Fifth People′s Hospital of Chengdu, Chengdu 611130, China;Department of Ultrasound, Chengdu Military General Hospital, Chengdu 610083, China;Department of Ultrasound, Chongzhou People′s Hospital, Chongzhou 611230, China;Department of Ultrasound, Second People′s Hospital of Chengdu, Chengdu 610000, China;Department of Ultrasound, Panzhihua Central Hospital, Panzhihua 617000, China;Department of Ultrasound, Mianyang Central Hospital, Mianyang 621000, China;Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;Department of Ultrasound, People′s Hospital of Deyang City, Deyang 618000, China;Department of Ultrasound, Yibin Second People′s Hospital, Yibin 644000, China;Department of Ultrasound, Suining Central Hospital, Suining 629000, China;Department of Ultrasound, Dazhou Central Hospital, Dazhou 635000, China;Department of Ultrasound, Jianyang People′s Hospital, Jianyang 641400, China;Department of Ultrasound, Third People′s Hospital of Chengdu, Chengdu 610031, China)

机构地区：[1]四川省人民医院超声科,成都610072 [10]成都市第一人民医院超声科,610000 [11]成都市第五人民医院超声科,611130 [12]成都军区总医院超声科,610083 [13]四川省崇州市人民医院超声科,611230 [14]成都市第二人民医院超声科,610000 [15]四川省攀枝花市中心医院超声科,617000 [2]四川省绵阳市中心医院超声科,621000 [3]川北医学院附属医院超声科,南充637000 [4]四川省德阳市人民医院超声科,618000 [5]四川省宜宾市第二人民医院超声科,644000 [6]四川省遂宁市中心医院超声科,629000 [7]四川省达州市中心医院超声科,635000 [8]四川省简阳市人民医院超声科,641400 [9]成都市第三人民医院超声科,610031

出　　处：《中华超声影像学杂志》2019年第5期419-424,共6页Chinese Journal of Ultrasonography

摘　　要：目的评价Kwak与ACR(2017)甲状腺影像报告和数据系统(TI-RADS)对甲状腺结节的诊断效能。方法收集2015年1月至2018年3月的甲状腺结节手术病例,高年资超声医师经过培训后,分别以Kwak和ACR TI-RADS分类方法回顾性分析甲状腺结节的超声征象。观察甲状腺结节12 712个,最终超声和手术病理资料完整的7 023例患者的7 023个结节纳入本研究。以甲状腺结节的实性、低回声或极低回声、纵横比≥1、边缘模糊、微钙化为超声恶性征象,计算恶性百分比,比较两种方法的诊断效能。结果①两种TI-RADS分类在良恶性结节之间差异有统计学意义(P<0.01);②Kwak和ACR诊断恶性结节的ROC曲线下面积分别为0.89和0.84,Youden指数分别为0.66和0.57;③以Kwak TI4B和ACR TR4为恶性的临界点,Kwak TI-RADS诊断的敏感性、特异性、阳性预测值、阴性预测值分别为75.0%、90.9%、83.2%、85.9%,准确性为84.9%;ACR TI-RADS诊断的敏感性、特异性、阳性预测值、阴性预测值分别为88.2%、68.9%、62.9%、90.8%,准确性为76.2%;Kwak TI4B和ACR TR4的Kappa值为0.52,χ^2=2 174.6,P<0.01。结论两种TI-RADS分类方法对甲状腺恶性结节的诊断价值均较高,Kwak TI-RADS分类方法整体效能优于ACR TI-RADS分类。Objective To evaluate the diagnostic efficacy of Kwak and ACR(2017) thyroid imaging reporting and data systems(TI-RADS) for thyroid nodules. Methods Cases of thyroid nodule who underwent surgery from January 2015 to March 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR TI-RADS classification methods. Totally, 12 712 thyroid nodules were observed, 7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study. Thyroid nodules with solid, hypoechoic or very hypoechoic, tall/wide ratio ≥1, margin ill-defined and microcalcification were classified as malignant signs of ultrasound. Malignant percentage was calculated and diagnostic tests were performed. Results ①There was a statistical difference between the benign and malignant nodules in the two types of TI-RADS classification (P<0.01).②The area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0.89 and 0.84, respectively. The Youden index of Kwak and ACR were 0.66 and 0.57, respectively.③Taking Kwak TI4B and ACR TR4 as critical points for malignancy, the sensitivity, specificity, positive predictive value and negative predictive value of Kwak TI4B were 75.0%, 90.9%, 83.2%, and 85.9%, respectively. The accuracy of Kwak TI4B was 84.9%;The sensitivity, specificity, positive predictive value and negative predictive value of ACR TR4 were 88.2%, 68.9%, 62.9%, and 90.8%, respectively. The accuracy of ACR TR4 was 76.2%. The Kappa value of Kwak TI4B and ACR TR4 was 0.52. The χ^2 value of Kwak TI4B and ACR TR4 was 2 174.6 (P<0.01). Conclusions The diagnostic values of two TI-RADS classification methods for thyroid malignant nodules are high. The overall efficiency of Kwak TI-RADS classification method is better than that of ACR TI-RADS classification method.

关 键 词：超声检查 甲状腺结节 甲状腺影像报告和数据系统 Kwak TI-RADS ACR TI-RADS 诊断效能 

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]