改良Kwak-TIRADS鉴别甲状腺结节良恶性的效能及影响因素分析  

Efficacy and Influencing Factors of Modified Kwak-TIRADS in Differentiating Benign and Malignant Thyroid Nodules

作　　者：谢轶峰[1] 师天雄[1] 刘晓真[1] 陈海燕[1] 高影嫦 Xie Yifeng;Shi Tianxiong;Liu Xiaozhen;Chen Haiyan;Gao Yingchang(Department of Ultrasound Imaging,Zhongshan People's Hospital,Zhongshan,Guangdong 528400,China)

机构地区：[1]广东省中山市人民医院超声影像科,广东省中山市528400

出　　处：《中国超声医学杂志》2022年第11期1205-1209,共5页Chinese Journal of Ultrasound in Medicine

基　　金：中山市社会公益科技研究项目(No.2018B1053)。

摘　　要：目的 评价改良Kwak甲状腺影像报告和数据系统(改良Kwak-TIRADS)对甲状腺结节良恶性的诊断效能及影响因素。方法 回顾性分析接受外科手术治疗甲状腺结节患者86例(共198个结节)的临床及超声影像资料。术前一周采用改良Kwak-TIRADS、甲状腺细胞病理学Bethesda报告系统(TBSRTC)分别对结节进行定性诊断。以术后切除标本病理结果为“金标准”,绘制ROC曲线分析两种分类方法的诊断效能,进一步分析可能导致误诊的相关影响因素。结果 198个甲状腺结节中,良性结节150个(75.76%),恶性结节48个(24.24%)。TBSRTC鉴别甲状腺结节良恶性的灵敏度(97.9%)、特异度(95.3%)及准确度(95.9%)均明显高于改良Kwak-TIRADS诊断甲状腺结节的灵敏度(75.0%)、特异度(88.7%)及准确度(86.9%)(P<0.05);TBSRTC对于直径≤1.0 cm的甲状腺结节诊断准确度(75%)高于改良Kwak-TIRADS(41.7%)(P<0.05)。单因素Logistic回归分析结果显示,甲状腺功能异常、结节直径≤1.0 cm、合并桥本病背景及纵横比≤1是影响诊断准确度的相关因素(P<0.05)。多因素分析结果显示,结节直径≤1.0 cm(OR=1.809,95%CI:1.099~2.974)、桥本病背景(OR=2.318,95%CI:1.262~4.254)及纵横比≤1(OR=1.975,95%CI:1.050~3.713)是影响改良Kwak-TIRADS诊断准确度的独立影响因素。结论 改良Kwak-TIRADS诊断甲状腺结节具有一定局限性,结节直径≤1 cm、桥本病背景及纵横比≤1是影响其诊断准确度的独立影响因素。Objective To evaluate the diagnostic efficiency and influencing factors of the modified Kwak thyroid imaging report and data system(modified Kwak-TIRADS) for benign and malignant thyroid nodules. Methods The clinical and ultrasound imaging data of 86 patients(198 nodules in total) who underwent surgery for thyroid nodules in Zhongshan People’s Hospital were retrospectively analyzed. One week before surgery, the nodules were qualitatively diagnosed by modified Kwak-TIRADS and Bethesda reporting system for thyroid cytopathology(TBSRTC). Taking the pathological results of postoperative resection specimens as the “gold standard”, the ROC curve was drawn to analyze the diagnostic performance of the two classification methods, and the related influencing factors that may lead to misdiagnosis were further analyzed. Results Among the 198 thyroid nodules, 150(75.76%) were benign and 48(24.24%) were malignant. The sensitivity(97.9%), specificity(95.3%) and accuracy(95.9%) of TBSRTC in differentiating benign and malignant thyroid nodules were significantly higher than those of modified Kwak-TIRADS in diagnosing thyroid nodules(75.0%) and specificity(88.7%). and accuracy(86.9%)(both P<0.05);the diagnostic accuracy(75%) of TBSRTC for thyroid nodules with a diameter of ≤1.0 cm was higher than that of modified Kwak-TIRADS(41.7%)(P<0.05);single Logistic regression analysis of factors showed that abnormal thyroid function, calculus nodule diameter ≤1.0 cm, Hashimoto’s disease background and aspect ratio ≤1 were related factors affecting the accuracy of diagnostic errors. The results of multivariate analysis showed that the nodule diameter was less than or equal to 1 cm(OR=1.809, 95%CI:1.099-2.974), the background of Hashimoto’s disease(OR=2.318, 95%CI:1.262-4.254), and the aspect ratio was less than or equal to 1(OR= 1.975, 95%CI:1.050-3.713) was an independent factor affecting the diagnostic accuracy of modified Kwak-TIRADS. Conclusions Modified Kwak-TIRADS has certain limitations in the diagnosis of thyroid nodu

关 键 词：甲状腺结节 改良Kwak-TIRADS 细胞病理学 诊断效能 影响因素 

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] R736.1[医药卫生—临床医学]