3种不同甲状腺结节分层系统的应用价值对比及误诊原因分析  

Comparison of three thyroid nodule stratification systems in the diagnosis of benign and malignant thyroid nodules

作　　者：曾伟 乐怀浙 孟国萍 李航 贲志飞[4] ZENG Wei;LE Huaizhe;MENG Guoping;LI Hang;BEN Zhifei(Graduate School of Medicine,Ningbo University,Ningbo 315211,China;不详)

机构地区：[1]宁波大学医学院研究生院,315211 [2]宁波市杭州湾医院超声科 [3]宁波市杭州湾医院麻醉科 [4]宁波市第二医院超声科

出　　处：《浙江医学》2023年第12期1292-1298,共7页Zhejiang Medical Journal

摘　　要：目的对比2020年中国甲状腺结节超声恶性危险分层指南(C-TIRADS)、2017年美国放射学会甲状腺影像报告与数据系统(ACR-TIRADS)与2011版Kwak甲状腺影像报告和数据系统(Kwak-TIRADS)对甲状腺良恶性结节的诊断效能及误诊原因分析。方法回顾性分析2019年3月至2022年5月于宁波市杭州湾医院行甲状腺手术切除或超声引导下细针穿刺活检且经病理检查明确诊断的568例患者679个结节声像图特点,分别用3种分层系统对结节进行分类,以病理检查结果为金标准,绘制结节在不同分层系统中的分类热图、分析误诊结节的韦恩图及3种分层系统诊断结节良恶性的ROC曲线。结果C-TIRADS、ACR-TIRADS、Kwak-TIRADS诊断甲状腺结节良恶性的最佳截断值分别为C-TIRADS中4B类、ACR-TIRADS中5类、Kwak-TIRADS中4C类,其相对应的灵敏度、特异度分别为0.803、0.620、0.670、0.707、0.790、0.617,差异均有统计学意义(均P<0.05);C-TIRADS联合ACR-TIRADS诊断的特异度为0.786,均高于两种分层系统单独诊断;灵敏度为0.583,低于两种分层系统单独诊断,差异有统计学意义(P<0.05)。3种分层系统均误诊的结节共111个,其中32个误诊为良性结节,声像图主要表现为仅含有粗大钙化或边缘钙化的实性低回声结节;79个误诊为恶性结节,声像图主要表现为纵横比>1的实性低回声结节。结论C-TIRADS诊断甲状腺结节良恶性的灵敏度较高,ACR-TIRADS诊断的特异度较高;C-TIRADS联合ACR-TIRADS能提高诊断特异度,减少临床诊断中的误诊;3种分层系统对仅含粗大钙化或边缘钙化的结节易误诊为良性结节,对纵横比>1的微小结节易误诊为恶性结节。Objective To compare the diagnostic efficiency of 2020 Chinese thyroid imaging reporting and data system(C-TIRADS),2017 thyroid imaging reporting and data system of ACR(ACR-TIRADS)and 2011 thyroid imaging reporting and data system of Kwak(Kwak-TIRADS)for benign and malignant thyroid nodules.Methods The ultrasonographic characteristics of 679 nodules resected from 568 patients and identified by pathological examination in Ningbo Hangzhou Bay Hospital from March 2019 to May 2022 were retrospectively analyzed.The nodules were classified with three stratification systems respectively,and the diagnostic efficiency of three systems was evaluated with pathological examination results as the gold standard.The classification heat map of nodules in different stratification systems was drawn,and the Wayne diagram of misdiagnosed nodules was analyzed,and the receiver operating characteristic curves(ROC)was used to assess the diagnostic value for benign and malignant nodules.Results The optimal cut-off values of C-TIRADS,ACRTIRADS and Kwak-TIRADS in the differential diagnosis of benign and malignant thyroid nodules were category 4B in CTIRADS,category 5 in ACR-TIRADS,and category 4C in Kwak-TIRADS,respectively.The corresponding sensitivity and specificity were 0.803,0.620,0.670,0.707,0.790 and 0.617,respectively(P<0.05).The specificity of C-TIRADS combined with ACR-TIRADS was 0.786,higher than that of the two guidelines alone,and the sensitivity was 0.583,lower than that of the two guidelines alone(P<0.05).A total of 111 nodules were misdiagnosed by all three stratification systems,including 32 nodules misdiagnosed as benign nodules,in which ultrasonography showed hypoechoic nodules containing only coarse calcification or marginal calcification;and 79 nodules misdiagnosed as malignant nodules,in which the ultrasonography showed solid hypoechoic nodules with aspect ratio>1.Conclusion C-TIRADS has higher sensitivity for differentiate diagnosis of benign and malignant thyroid nodules,while ACR-TIRADS has higher specificity among

关 键 词：甲状腺结节 超声检查 指南 

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]