甲状腺滤泡性肿瘤超声风险分层系统鉴别甲状腺滤泡癌和滤泡腺瘤的临床价值  

Clinical value of the Thyroid Follicular Tumor Ultrasound Risk Stratification System in differentiating thyroid follicular carcinoma and follicular adenoma

作　　者：肖丽珊 李昱臣 闫萌萌 杜梅霞 赵诚[1] 宁春平[1] Xiao Lishan;Li Yuchen;Yan Mengmeng;Du Meixia;Zhao Cheng;Ning Chunping(Department of Abdominal Ultrasound,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院腹部超声科,青岛266000

出　　处：《中华超声影像学杂志》2024年第9期791-799,共9页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划项目(2022YFC2503302);山东省自然科学基金(ZR2020MH290)。

摘　　要：目的:评估甲状腺滤泡性肿瘤超声风险分层系统(F-TIRADS)鉴别甲状腺滤泡癌(FTC)与滤泡腺瘤(FTA)的价值,并对比分析其与其他风险分层系统(RSS)的效能差异。方法:回顾性收集2016年1月至2023年12月于青岛大学附属医院接受甲状腺超声检查且术后组织病理诊断为FTC和FTA的325例患者的327枚结节,分为FTC组(81枚)和FTA组(246枚)。由2名超声医师根据F-TIRADS、2020年中国甲状腺结节超声恶性危险分层指南(C-TIRADS)、2015年美国甲状腺协会成人甲状腺结节与分化型甲状腺癌诊治指南(ATA指南)及2017年欧洲甲状腺协会甲状腺成像报告和数据系统(EU-TIRADS)对结节进行分类。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。以术后病理结果为金标准,比较4种RSS的诊断效能。结果:多因素Logistic回归分析显示结节最大径、成分、回声、边缘、钙化、小梁样结构及彩色多普勒血流是预测FTC发生的独立预测因素(OR=1.914、3.427、9.926、9.163、45.918、3.191、8.936,均P<0.05)。在同一RSS中实际恶性率逐层增高且与推荐恶性率相符或接近(ATA指南除外)。四种RSS鉴别FTC及FTA的最佳截断值分别为F-TIRADS中FTC风险50%~90%、C-TIRADS 4B、ATA指南中度可疑结节、EU-TIRADS 4类,曲线下面积分别为0.916、0.808、0.827及0.836,其中F-TIRADS综合效能最佳(敏感性为82.72%,特异性为82.93%),与C-TIRADS、ATA指南及EU-TIRADS比较差异有统计意义(均P<0.05)。结论:F-TIRADS能够有效鉴别FTA和FTC,诊断效能明显优于C-TIRADS、ATA指南及EU-TIRADS。在临床工作中对于边界不清或成角、有边缘/环形钙化、以中心为主的血流或具小梁样结构的实性低回声结节要予以高度警惕。ObjectiveTo assess the discriminatory value of the Thyroid Follicular Tumor Ultrasound Risk Stratification System(F-TIRADS)in differentiating follicular thyroid carcinoma(FTC)from follicular thyroid adenoma(FTA),and to compare its performance with other risk stratification systems(RSS).MethodsA retrospective analysis was conducted on 325 patients(327 thyroid nodules)diagnosed postoperatively as FTC or FTA at Affiliated Hospital of Qingdao University from January 2016 to December 2023.The cases were divided into FTC group(81 nodules)and FTA group(246 nodules).The nodules were classified based on F-TIRADS,the 2020 Chinese Thyroid Imaging Reporting and Data System(C-TIRADS),the 2015 American Thyroid Association guidelines(ATA guidelines),and the 2017 European Thyroid Association Thyroid Imaging Reporting and Data System(EU-TIRADS)by two ultrasound physicians.Multivariate Logistic regression analysis was used to identify independent predictors associated with FTC.Diagnostic performance of the 4 RSS was compared using postoperative pathological results as the gold standard.ResultsMultivariate Logistic regression analysis showed maximum diameter,solid composition,hypoechogenicity,unclear or angular margins,marginal or ring calcifications,trabecular structure,and central blood flow were independent predictors of FTC(OR=1.914,3.427,9.926,9.163,45.918,3.191,8.936,respectively;all P<0.05).Within each RSS,the actual malignancy rate increased with higher risk categories,aligning closely with the recommended malignancy rates(except for ATA guidelines).The optimal cut-off values for distinguishing FTC from FTA were FTC risk 50%-90%in F-TIRADS,C-TIRADS 4B,moderately suspicious nodules in ATA guidelines,and EU-TIRADS 4,with areas under the curve of 0.916,0.808,0.827,and 0.836,respectively.F-TIRADS demonstrated the best overall performance(sensitivity:82.72%,specificity:82.93%),with significant differences compared with C-TIRADS,ATA guidelines,and EU-TIRADS(all P<0.05).ConclusionsF-TIRADS is highly effective in distinguishing FTA

关 键 词：超声检查 甲状腺滤泡癌 甲状腺滤泡性腺瘤 甲状腺滤泡性肿瘤超声风险分层系统 鉴别诊断 

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