C-TIRADS超声词典在甲状腺滤泡性肿瘤鉴别诊断中的价值分析  

Value of C-TIRADS Ultrasound Dictionary in Differential Diagnosis of Malignant and Benign Thyroid Follicular Tumors

作　　者：张小 姚劲草 付凯文 欧笛 史芳 田源 高露 徐栋[3] ZHANG Xiao;YAO Jincao;FU Kaiwen;OU Di;SHI Fang;TIAN Yuan;GAO Lu;XU Dong(Zhejiang Chinese Medical University,Hangzhou 310053,China;The First People’s Hospital of Hangzhou Lin’an District,Hangzhou 311300,China;Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China;National Health Commission Capacity Building and Continuing Education Center,Beijing 100098,China)

机构地区：[1]浙江中医药大学研究生院,浙江杭州310053 [2]杭州市临安区第一人民医院,浙江杭州311300 [3]浙江省肿瘤医院,中国科学院杭州医学研究所,浙江杭州310022 [4]国家卫生健康委能力建设和继续教育中心,北京100098

出　　处：《肿瘤学杂志》2023年第12期1033-1039,共7页Journal of Chinese Oncology

基　　金：国家自然科学基金(82071946);浙江省自然科学基金(LZY21F030001);浙江省卫生健康科技计划(2021KY099,2022KY110,2023KY066)。

摘　　要：[目的]探讨中国超声甲状腺影像报告和数据系统(Chinese-Thyroid Imaging Reporting and Data System,C-TIRADS)超声词典在鉴别甲状腺滤泡性肿瘤良恶性中的价值。[方法]回顾性分析2008年3月至2022年12月于浙江省肿瘤医院接受治疗的495例患者,其中甲状腺滤泡性腺瘤(follicular thyroid adenoma,FTA)379例,甲状腺滤泡癌(follicular thyroid carcinoma,FTC)116例,以病理结果为金标准,所有甲状腺结节根据C-TIRADS分级标准进行评估,对FTA和FTC的临床和超声图像特征进行统计分析,并进行Logistic回归分析构建三种预测模型,评价相关模型在鉴别诊断FTC中的诊断效能。[结果]FTA与FTC在边缘、回声、内部结构、局灶性强回声、声晕及血流模式方面差异具有统计学意义(P<0.05),低回声、实性、形态不规则、边缘模糊、向甲状腺外侵犯、粗大钙化与内部血流丰富是FTC的独立危险因素。单一超声特征及单纯C-TIRADS危险分层对FTC的诊断效能较差(AUC为0.577~0.657),通过Logistic回归分析构建的三个预测模型对FTC均有较好的诊断效能(模型1 AUC=0.734,模型2 AUC=0.756,模型3 AUC=0.782)。[结论]C-TIRADS超声词典对甲状腺滤泡性肿瘤良恶性鉴别具有诊断价值,联合回声、声晕、局灶性强回声及血流模式等超声特征可有效提高C-TIRADS危险分层对FTC的诊断能力。[Objective]To evaluate the application of the C-TIRADS ultrasound dictionary in differentiating between benign and malignant thyroid follicular tumors.[Methods]The clinical and imaging data of 495 patients with thyroid tumors admitted in Zhejiang Cancer Hospital from March 2008 to December 2022 were retrospectively reviewed,including 379 cases of follicular thyroid adenoma(FTA)and 116 cases of follicular thyroid carcinoma(FTC),all thyroid nodules were evaluated according to CTIRADS standard.Three predictive models were constructed using Logistic regression analysis.Using pathological results as the gold standard the diagnostic efficacy of the models in the differential diagnosis between FTA and FTC was evaluated with the area under ROC curve(AUC).[Results]There were significant differences in edge,echo,internal structure,focal hyperechogenicity,acoustic halo,and blood flow pattern between FTA and FTC(P<0.05).Low echo,solid,irregular margin,ill-defined,extrathyroidal extension,macrocalcifications or peripheral calcifications,and rich internal blood flow were identified as independent risk factors for FTC.The diagnostic efficacy of single ultrasound features and simple C-TIRADS risk stratification for FTC was poor(AUC:0.577~0.657),while the three prediction models constructed with logistic regression analysis showed good diagnostic efficacy for FTC(Model 1 AUC=0.734,Model 2 AUC=0.756,Model 3 AUC=0.782).[Conclusion]The C-TIRADS ultrasound dictionary has certain value in differentiating diagnosis between benign and malignant thyroid follicular tumors.Combining ultrasound features such as echoes,halos,focal hyperechogenicity,and blood flow patterns can effectively improve the diagnostic ability of C-TIRADS risk stratification for FTC.

关 键 词：甲状腺滤泡癌 甲状腺滤泡性腺瘤 C-TIRADS LOGISTIC回归 

分 类 号：R736.1[医药卫生—肿瘤]