评估中国版甲状腺影像报告与数据系统鉴别甲状腺滤泡癌与滤泡腺瘤的价值  

Evaluation of the value of the Chinese-Thyroid Imaging Reporting and Data System in differentiating thyroid follicular carcinoma from follicular adenoma

作　　者：马超[1] 姜若愚[1] 赵科[1] 张杰[1] 康楠[1] 肖明[1] Ma Chao;Jiang Ruoyu;Zhao Ke;Zhang Jie;Kang Nan;Xiao Ming(Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院普外科,天津300052

出　　处：《中华内分泌外科杂志》2023年第5期598-602,共5页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金(82073287);天津市教委科研计划项目(2020KJ153)。

摘　　要：目的评估中国版甲状腺影像报告与数据系统(Chinese-Thyroid Imaging Reporting and Data System,C-TIRADS)定义的超声图像特征及分类鉴别甲状腺滤泡癌(follicular thyroid carcinoma,FTC)与甲状腺滤泡腺瘤(follicular thyroid adenoma,FTA)的价值。方法回顾性分析2019年1月至2023年2月天津医科大学总医院接受甲状腺结节相关手术且术后病理证实为FTC或FTA患者87例,分为FTC组(26例)和FTA组(61例)。比较两组一般资料、术前细胞学病理诊断、手术方式、甲状腺结节超声图像特征及C-TIRADS分类差异。应用多因素Logistic回归分析筛选与FTC发生相关的独立预测因素,基于独立预测因素建立回归模型并绘制列线图,应用Bootstrap法对列线图进行内部验证,绘制ROC曲线及校准曲线以评估列线图的诊断效能和预测能力。结果超声图像特征(方位、回声、结构、钙化、边缘、声晕)及C-TIRADS分类组间差异有统计学意义(均P<0.05);超声图像特征(最大径、回声质地、血流)、一般资料、术前细胞学病理诊断及手术方式组间差异无统计学意义(均P>0.05);单因素Logistic回归分析显示垂直位、周边钙化、边缘模糊/不规则或外侵、C-TIRADS 4B/4C类是预测FTC发生的候选变量(OR=10.909、19.059、19.259、49.333,均P<0.05);多因素Logistic回归分析显示周边钙化、边缘模糊/不规则或外侵、C-TIRADS 4B/4C类是FTC发生的独立预测因素(OR=33.731、11.620、22.794,均P<0.05)。基于上述3项独立预测因素构建FTC发生的列线图预测模型,AUC为0.920(95%CI=0.854~0.986),显示列线图具有较高诊断效能,依据约登指数确定最佳诊断阈值为0.23(对应列线图总分约为52分),敏感度为88.5%,特异度为82.0%;内部验证所绘制校准曲线靠近参考线,提示该列线图具有较高预测能力。结论基于C-TIRADS定义的超声图像特征及分类构建的FTC发生的列线图预测模型,具有较高的诊断效能和预测能力,能对术前�Objective To evaluate the value of ultrasonographic features and classification defined by the Chinese-Thyroid Imaging Reporting and Data System(C-TIRADS)in differentiating follicular thyroid carcinoma(FTC)from follicular thyroid adenoma(FTA).Methods Data of 87 patients who underwent thyroid nodule-related surgery at Tianjin Medical University General Hospital from Jan.2019 to Feb.2023 and whose postoperative pathology confirmed FTC or FTA was divided into FTC group(26 cases)and FTA group(61 cases)were retrospectively analyzed.The differences of general data,pathological diagnosis,surgical methods,ultrasonographic features of thyroid nodules and C-TIRADS classification between the two groups were compared.Multivariate Logistic regression analysis was used to screen the independent predictors related to the occurrence of FTC,a regression model was established based on the independent predictors and a nomogram was drawn.Bootstrap method was used to verify the nomogram internally,and ROC curve and calibration curve were drawn to evaluate the diagnostic efficiency and predictive ability of the nomogram.Results There were statistically significant differences between orientation,echo,composition,calcification,margin,halo and C-TIRADS classification between groups(all P<0.05);maximum diameter,echotexture,blood flow,general data,pathological diagnosis and surgical methods had no statistically significant differences between groups(all P>0.05).Single-factor logistic regression analysis showed taller-than-wide,peripheral calcification,blurred/irregular edges or external invasion,C-TIRADS 4B/4C class were candidate variables for predicting the occurrence of FTC(OR=10.909,19.059,19.259,49.333,all P<0.05).Multivariate logistic regression analysis showed that peripheral calcification,blurry/irregular edges or extra-thyroid invasion,C-TIRADS 4B/4C class were independent predictors for the occurrence of FTC(OR=33.731,11.620,22.794,all P<0.05).The nomogram of FTC occurrence was constructed based on the above three independent pr

关 键 词：超声检查 甲状腺滤泡癌 甲状腺滤泡腺瘤 中国版甲状腺影像报告与数据系统 列线图 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]