超声联合甲状腺影像报告和数据系统评估甲状腺结节恶性风险  

Ultrasound combined with thyroid imaging reporting and data system for assessment of malignant risk of thyroid nodules

作　　者：胡蓉 许诺 曹淑娟[1] 孙洪军[1] 李菲 王艺璇 张佩佩 王蓓[1] HU Rong;XU Nuo;CAO Shujuan;SUN Hongjun;LI Fei;WANG Yixuan;ZHANG Peipei;WANG Bei(Department of Ultrasound,Shandong Provincial Qianfoshan Hospital,Shandong University,Jinan 250014,China)

机构地区：[1]山东大学附属千佛山医院超声科,山东济南250014

出　　处：《中国医学影像技术》2020年第12期1790-1794,共5页Chinese Journal of Medical Imaging Technology

基　　金：山东省医药卫生科技发展计划项目(2015WS0232)。

摘　　要：目的对比观察超声联合我国国家卫生健康委员会(NHC)甲状腺影像报告和数据系统(TI-RADS)与美国放射学会(ACR)TI-RADS判断甲状腺良恶性结节的价值。方法回顾性分析132例甲状腺结节患者共173个结节,评价结节超声特征及其NHC TI-RADS、ACR TI-RADS分类;以病理结果为金标准,采用受试者工作特征(ROC)曲线比较2种方法的诊断效能。根据结节最大径将其分为≤1 cm组、>1 cm且≤2 cm组和>2 cm组,以多元Logistic回归分析甲状腺良恶性结节的预测因素。结果 NHC与ACR TI-RADS分类ROC曲线下面积(AUC)分别为0.91、0.92,最佳截断值分别为≥4c类、≥5类,敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及准确率分别为87.36%、88.37%、88.37%、87.36%、 87.86%和83.91%、89.53%、89.02%、84.62%、86.71%(P均>0.05),一致性较好(Kappa=0.86)。≤1 cm组纵横比>1时恶性风险高,OR为12.07[95%CI(2.49,58.63)];>1 cm且≤2 cm组纵横比>1、存在微钙化和不规则或分叶时恶性风险高,OR分别为21.00[95%CI(2.31,191.17)]、14.88[95%CI(3.14,70.50)]及48.75[95%CI(5.99,396.50)];>2 cm组存在微钙化、不规则或分叶和甲状腺外侵犯时恶性风险高,OR分别为51.33[95%CI(7.24,364.03)]、18.50[95%CI(1.36,252.27)]及27.75[95%CI(2.31,333.76)]。结论 NHC与ACR TI-RADS分类诊断甲状腺结节均有较高效能;不同超声征象对不同大小甲状腺结节的诊断效能不同。Objective To compare the diagnostic value of ultrasound combined with thyroid imaging reporting and data system(TI-RADS)issued by National Health Commission(NHC TI-RADS)of People's Republic of China and American College of Radiology(ACR TI-RADS)in differentiating benign and malignant thyroid nodules.Methods Totally 173 thyroid nodules in 132 patients were retrospectively analyzed.Ultrasonic characteristics of the nodule were evaluated,and then the nodules were classified with NHC TI-RADS and ACR TI-RADS,respectively.Taken pathology as the gold standard,the receiver operating characteristic(ROC)curve was used to compare the diagnostic efficacy of NHC TI-RADS and ACR TI-RADS.Then the nodules were divided into≤1 cm group,>1 cm and≤2 cm group and>2 cm group according to the maximum diameters.Multivariate Logistic regression was used to analyze the predictive factors of benign and malignant thyroid nodules in 3 groups.Results The area under the curve(AUC)of ROC of NHC TI-RADS and ACR TI-RADS was 0.91 and 0.92,respectively,and the best cutoff value of NHC TI-RADS and ACR TI-RADS was≥4c and≥5,respectively.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of NHC TI-RADS and ACR TI-RADS were 87.36%,88.37%,88.37%,87.36%,87.86%and 83.91%,89.53%,89.02%,84.62%,86.71%,respectively(all P>0.05),with good consistency(Kappa=0.86).In≤1 cm group,taller-than-wide indicated high risk of malignancy,OR was 12.07(95%CI[2.49,58.63]).In>1 cm and≤2 cm group,taller-than-wide,microcalcification and irregular or lobulated indicted high risk of malignancy,OR were 21.00(95%CI[2.31,191.17]),14.88(95%CI[3.14,70.50])and 48.75(95%CI[5.99,396.50]),respectively.For>2 cm nodules,microcalcification,irregularity or lobulated and extra-thyroidal extension predicted high risk of malignancy,OR were 51.33(95%CI[7.24,364.03]),18.50(95%CI[1.36,252.27])and 27.75(95%CI[2.31,333.76]),respectively.Conclusion Both NHC and ACR TI-RADS present high diagnostic efficiency for differentiating benign and mal

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]