甲状腺髓样癌超声诊断质量分析及改进措施  

Ultrasonic diagnosis of medullary thyroid carcinoma: quality analysis and improvement measures

作　　者：张晓燕 李文波[1] 姜玉新[1] 朱庆莉[1] 张青 王红燕 李建初 Xiaoyan Zhang;Wenbo Li;Yuxin Jiang;Qingli Zhu;Qing Zhang;Hongyan Wang;Jianchu Li(Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院超声医学科,100730

出　　处：《中华医学超声杂志(电子版)》2024年第11期1024-1029,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-A-224)。

摘　　要：目的分析甲状腺髓样癌(MTC)超声诊断质量情况,探讨提高超声诊断MTC准确性的措施。方法总结2019年1月至2022年12月北京协和医院经病理诊断的81例MTC患者的术前资料,分析超声检查存图、报告描述、诊断符合情况和分类指南应用率。应用美国甲状腺协会(ATA)指南、美国放射学会甲状腺影像报告与数据系统(ACR-TIRADS)及2020年甲状腺结节超声恶性危险分层中国指南(C-TIRADS)对81例MTC声像图进行回顾性评估。由2名医师应用上述3种指南对甲状腺结节重新进行风险分层或分类。采用χ^(2)检验比较初、中级职称组(35例)与高级职称组(46例)、甲状腺专业组(27例)与非甲状腺专业组(54例)超声存图完整率、报告描述完整率、超声诊断符合率和指南应用率的组间差异,比较应用指南组与未应用指南组原始超声报告诊断符合率的差异,比较原始超声报告诊断与应用ATA、ACR-TIRADS及C-TIRADS分类诊断准确性的差异。结果MTC的超声存图完整率为88.9%(72/81)、报告描述完整率为92.6%(75/81)、超声诊断符合率为87.7%(71/81)、指南应用率为54.3%(44/81)。初、中级职称组与高级职称组、甲状腺专业组与非甲状腺专业组医师的超声存图完整率、报告描述完整率、诊断符合率、指南应用率比较,差异均无统计学意义(P均>0.05)。应用指南组和未应用指南组的原始超声报告诊断符合率分别为100%(44/44)和73.0%(27/37),差异具有统计学意义(χ^(2)=11.184,P<0.001)。重新应用ATA、ACR-TIRADS及C-TIRADS对MTC的诊断符合率高于原始超声报告诊断符合率(97.5%、97.5%、97.5% vs 87.7%),差异具有统计学意义(χ^(2)=7.551,P=0.006)。结论MTC的术前原始超声报告诊断符合率较高,但低于应用ATA、ACR-TIRADS及C-TIRADS的诊断符合率。超声医师应熟悉MTC的声像图特征,应用甲状腺结节超声恶性风险分层指南,结合临床及实验室检查结果,以进一步提高超声诊断ObjectiveTo analyze the quality of ultrasonic diagnosis of medullary thyroid carcinoma (MTC) and propose measures to improve its accuracy.MethodsEighty-one patients with MTC diagnosed by pathology were reviewed at Peking Union Medical College Hospital from January 2019 to December 2022. The sonograms of all the MTCs were retrospectively analyzed using the American Thyroid Association (ATA) risk stratification guidelines, the American College of Radiology thyroid imaging report and data system (ACR-TIRADS), and the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS). Thyroid nodules were re-risk-stratified or classified by 2 physicians using the above three guidelines. The Chi-square test was used to compare the differences in sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, and guideline application rate between physicians with primary or intermediate title (35 cases) and those with senior title (46 cases), and between thyroid professionals (27 cases) and non-thyroid professionals (54 cases), the difference in the coincidence rate of diagnosis made on original ultrasound reports between the group using guidelines and the group not using, and the differences in accuracy of ultrasound report diagnosis, ATA, ACR-TIRADS, and C-TIRADS classification diagnosis.ResultsThe sonogram completeness rate for MTC was 88.9% (72/81), the report description completeness rate was 92.6% (75/81), the ultrasound diagnostic coincidence rate was 87.7%(71/81), and the guidelines application rate was 54.3% (44/81). There was no statistically significant difference(P>0.05) in the sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, or guidelines application rate between the primary and intermediate title group and the senior title group, and between the thyroid professional group and non-professional group. The coincidence rates of diagnosis made on original ultrasound reports in the guidelines application group and non-ap

关 键 词：甲状腺髓样癌 超声 诊断质量 

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