三种甲状腺影像报告和数据系统推荐细针穿刺抽吸的不必要活检率的比较  

Comparison of Unnecessary Biopsy Rates for Fine Needle Aspiration as Recommended by Three Thyroid Imaging Reporting and Data Systems

作　　者：张卫兵[1] 陈晓 何贝丽 陈喆 刘华[1] 刘禹 徐闻[3] Zhang Weibing;Chen Xiao;He Beili;Chen Zhe;Liu Hua;Liu Yu;Xu Wen(Department of Ultrasound,Jiangsu Corps Hospital,Chinese People's Armed Police Forces,Yangzhou,Jiangsu 225003,China;Health Management Center,Northern Jiangsu People's Hospital,Yangzhou,Jiangsu 225o01,China;Department of Medical Imaging,Beijing Corps Hospital,Chinese People's Armed Police Forces,Beijing 100039,China)

机构地区：[1]武警江苏总队医院超声科,江苏省扬州市225003 [2]苏北人民医院健康管理中心,江苏省扬州市225001 [3]武警北京总队医院医学影像科,北京市100039

出　　处：《中国超声医学杂志》2024年第8期858-861,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的比较2020年中国甲状腺影像报告和数据系统(C-TIRADS)、2017年美国放射学会甲状腺影像报告和数据系统(ACR TI-RADS)、2011年Kwak提出的甲状腺影像报告和数据系统(KwakTI-RADS)推荐细针穿刺抽吸(FNA)的不必要活检率(UBR)。方法以FNA或手术病理结果为金标准,计算并比较分析3种TI-RADS分类诊断629例甲状腺结节的效能和推荐FNA的特异度、灵敏度及假阳性(UBR)。结果C-TIRADS、ACRTI-RADS及KwakTI-RADS曲线下面积(AUC)分别为0.912(95%CI:0.886~0.938)、0.888(95%CI:0.857~0.918)和0.899(95%CI:0.871~0.926),C-TIRADS高于其他两种TI-RADS(P<0.05)。C-TIRADS、ACR TI-RADS及KwakTI-RADS推荐FNA的UBR分别为24.1%(60/249)、15.8%(29/184)、30.0%(71/237),ACRTI-RADS低于其他两种TI-RADS(P<0.05),ACRTI-RADS与C-TIRADS差异无统计学意义(X^(2)=3.615,P=0.057)。若C-TIRADS仅考虑结节大小推荐FNA,则有54个恶性结节(C-TIRADS4a类1个、4b类3个、4c类40个及5类10个)失去FNA机会,其UBR为30.8%(60/195),高于C-TIRADS推荐FNA的UBR,但差异无统计学意义(X^(2)=2.469,P=0.116)。结论综合考虑3种TI-RADS分类诊断效能及推荐FNA的UBR,C-TIRADS更值得临床应用于甲状腺结节恶性风险评估,指导是否需要行FNA更符合临床实际。Objective To compare the unnecessary biopsy rates(UBR)of fine needle aspiration(FNA)as recommended by 2020 Chinese thyroid imaging reporting and data system(C-TIRADS),2017 American College of Radiology thyroid imaging reporting and data system(ACR TI-RADS),and the thyroid imaging reporting and data system proposed by Kwak in 2011(Kwak TI-RADS).Methods Taking FNA or surgical pathology as the gold standard,the diagnostic efficiency and the specificity,sensitivity,and false positive(UBR)of recommended FNA for the diagnosis of 629 thyroid nodules using three TIRADSs were calculated and compared.Results The area under the curve(AUC)of C-TIRADS,ACR TI-RADS,and Kwak TI-RADS were 0.912(95%CI:0.886~0.938),0.888(95%CI:0.857~0.918),and 0.899(95%CI:0.871~0.926),respectively.That of C-TIRADS was higher than those of the other two TI-RADS(P<0.05).The UBRs for FNA recommended by C-TIRADS,ACR TI-RADS,and Kwak TI-RADS were 24.1%(60/249),15.8%(29/184),and 30.0%(71/237),respectively.The rate by ACR TI-RADS was lower than those by the other two TI-RADSs(P<0.05),and there was no statistically significant difference between ACR TI-RADS and C-TIRADS(X^(2)=3.615,P=0.057).If C-TIRADS recommended FNA only based on nodule size,a total of 54 malignant nodules(one nodule in C-TIRADS 4a,3 in 4b,40 in 4c,and 10 in 5)would lose the opportunity for FNA,and the UBR was 30.8%(60/195),which was higher than that recommended FNA by C-TIRADS,but the difference was not statisti-cally significant(X²=2.469,P=0.116).Conclusions Considering the diagnostic efficiency and the UBR of recommended FNA of three TI-RADSs,C-TIRADS more worthy of clinical application in thyroid nodule malignant risk assessment,and guidance on whether FNA more in line with clinical practice.

关 键 词：甲状腺结节 甲状腺影像报告和数据系统 细针穿刺抽吸 不必要活检率 

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]