不同TI-RADS指南预测甲状腺囊实性结节恶性风险分层价值的对比研究  

Value of different TI-RADS guidelines in predicting the risk stratification of partially cystic thyroid nodules:a comparative study

作　　者：刘淑 刘晏均 马卓群 赵艳茹 魏炜[2] 施秉银[1] LIU Shu;LIU Yanjun;MA Zhuoqun;ZHAO Yanru;WEI Wei;SHI Bingyin(Department of Endocrinology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院内分泌代谢科,西安市710061 [2]西安交通大学第一附属医院超声医学科,西安市710061

出　　处：《临床超声医学杂志》2023年第3期161-165,共5页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(81970679);陕西省自然科学基础研究计划项目(2019JQ-946)。

摘　　要：目的比较ACR TI-RADS、ATA指南及KSThR指南预测甲状腺囊实性结节恶性风险分层的价值。方法回顾性分析经病理证实的293个甲状腺囊实性结节(良性210个,恶性83个)的超声表现特征,应用不同TI-RADS指南对甲状腺囊实性结节进行恶性风险分层,多因素Logistic回归筛选甲状腺囊实性恶性结节的危险因素;绘制受试者工作特征(ROC)曲线分析不同TI-RADS对甲状腺囊实性结节良恶性的预测效能。结果甲状腺囊实性良恶性结节大小、结构成分及实性成分为低回声、实性成分为偏心位、偏心位实性成分与囊壁成锐角、微钙化、边界不规则占比比较差异均有统计学意义(均P<0.05)。ACR TI-RADS将良性结节分为极低危135个、低危46个、中危27个、高危2个,恶性结节分为极低危9个、低危13个、中危47个、高危14个;ATA指南将良性结节分为极低危158个、低危38个、高危14个,恶性结节分为极低危22个、低危8个、高危53个;KSThR指南将良性结节分为中危14个、低危187个、良性9个,恶性结节分为中危53个、低危28个、良性2个。多因素Logistic回归分析显示,实性成分为低回声、微钙化、边界不规则均为甲状腺囊实性恶性结节的危险因素(OR=6.684、2.459、2.587,均P<0.05)。ROC曲线分析显示,ACR TI-RADS、ATA指南、KSThR指南预测甲状腺囊实性结节良恶性的曲线下面积分别为0.843(95%可信区间:0.791~0.895)、0.797(95%可信区间:0.733~0.862)、0.785(95%可信区间:0.717~0.852)。结论ACR TI-RADS预测甲状腺囊实性结节恶性风险分层的价值优于ATA指南及KSThR指南。Objective To compare the value of ACR TI-RADS,ATA guideline and KSThR guideline in predicting the risk stratification of partially cystic thyroid nodules.Methods The sonographic features of 293 partially cystic thyroid nodules(210 benign and 83 malignant)confirmed by pathology were retrospectively analyzed,different TI-RADS were used in the risk stratification of partially cystic thyroid nodules,and the risk factors of malignant partially cystic thyroid nodules were screened by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of different TI-RADS for benign and malignant partially cystic thyroid nodules.Results There were statistically significant differences between benign and malignant nodules in size,solid structure and the proportion of solid part presented hypoecho,solid part presented eccentric growth,acute angle of cystic wall,microcalcification and irregular boundary(all P<0.05).According to ACR TI-RADS,benign nodules were divided into 135 very low-risk,46 low-risk,27 intermediate-risk,and 2 highrisk,while the malignant nodules were divided into 9 very low-risk,13 low-risk,47 intermediate-risk,and 14 high-risk.According to ATA guideline,benign nodules were divided into 158 very low-risk,38 low-risk,and 14 high-risk,while the malignant nodules were divided into 22 very low-risk,8 low-risk,and 53 high-risk.According to KSThR guideline,benign nodules were divided into 14 intermediate-risk,187 low-risk,and 9 benign,while the malignant nodules were divided into 53 intermediate-risk,28 low-risk and 2 benign.Multivariate Logistic regression analysis showed that solid part presented hypoecho,microcalcification and irregular boundary were all risk factors for malignant partially cystic thyroid nodules(OR=6.684,2.459,2.587,all P<0.05).ROC curve analysis showed that the areas under the curve of ACR TI-RADS,ATA guideline and KSThR guideline in predicting benign and malignant partially cystic thyroid nodules were 0.843(95%confidence interval:0.79

关 键 词：超声检查 TI-RADS ATA指南 KSThR指南 甲状腺囊实性结节 良恶性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]