比较3种不同分类方法诊断甲状腺结节的价值  

Compare the value of diagnosing thyroid nodules by three different classification methods

作　　者：杨金君 邵春晖[2] 罗永科 吕品[2] 葛欣 Yang Jinjun;Shao Chunhui;Luo Yongke;Lyu Pin;Ge Xin(Department of Ultrasound Medicine,The First People′s Hospital of Xianyang,Xianyang 712000,China;Department of Ultrasound,Baoji People′s Hospital,Baoji 721000,China)

机构地区：[1]咸阳市第一人民医院超声医学科,咸阳712000 [2]宝鸡市人民医院超声医学科,宝鸡721000

出　　处：《中国临床实用医学》2025年第1期30-35,共6页China Clinical Practical Medicine

基　　金：宝鸡市卫生健康委员会2024年度科研计划立项课题(2024-052);宝鸡市卫生健康委员会2025年度科研计划立项课题(2025-079)。

摘　　要：目的比较2017版美国放射学会甲状腺影像报告和数据系统(ACR TI-RADS)、2020版中国甲状腺影像报告和数据系统(C-TIRADS)及第3版甲状腺细胞病理学Bethesda报告系统(TBSRTC)3种分类方法对甲状腺结节良恶性的诊断能力。方法本研究为横断面研究,选取2022年2月至2024年2月于咸阳市第一人民医院超声医学科行超声引导下细针穿刺细胞学检查的569例甲状腺结节患者(592个结节),男206例,女363例,年龄(40.94±3.25)岁,年龄范围为15~70岁。比较患者的一般资料及超声征象,比较ACR TI-RADS、C-TIRADS、TBSRTC分类鉴别诊断甲状腺结节良恶性的价值,绘制3种分类方法诊断甲状腺结节良恶性的受试者操作特征(ROC)曲线,比较各组间诊断效能。结果以术后组织病理为诊断"金标准",在592个结节中,TBSRTCⅠ类结节226个,Ⅱ类结节49个,Ⅲ类结节70个,Ⅳ类结节138个,Ⅴ类结节63个,Ⅵ类结节46个。因本研究中226个TBSRTCⅠ类结节为无异常或无法诊断而排除。其余366个TBSRTCⅡ~Ⅵ类结节中,良性结节123个,恶性结节243个。良性结节与恶性结节患者的年龄、结节经线、结节大小分布、结节血流分布、结节构成、结节纵横比、结节边缘、结节回声、结节钙化特征、TBSRTCⅡ~Ⅵ类结节分布比较,差异有统计学意义(P<0.05)。ACR TI-RADS诊断甲状腺结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值及总符合率分别为95.06%、80.49%、90.59%、89.19%、90.16%。C-TIRADS诊断的灵敏度、特异度、阳性预测值、阴性预测值及总符合率分别为96.30%、81.30%、91.05%、91.74%、91.26%。TBSRTC诊断的灵敏度、特异度、阳性预测值、阴性预测值及总符合率分别为96.30%、89.43%、94.74%、92.44%、93.17%。ACR TI-RADS曲线下面积为0.878(95%CI:0.840~0.909),C-TIRADS曲线下面积为0.888(95%CI:0.851~0.918),TBSRTC曲线下面积为0.929(95%CI:0.897~0.953),C-TIRADS与ACR TI-RADS的ROC曲线成对比较,差异ObjectiveTo compare the diagnostic capability of the 2017 American College of Radiology thyroid imaging-reporting and data system(ACR TI-RADS),the 2020 China-thyroid imaging reporting and data system(C-TIRADS)and the 3 version of the Bethesda system for reporting thyroid cytopathology(TBSRTC)for benign and malignant thyroid nodules.MethodsThis study was a cross-sectional study,a total of 569 patients with thyroid nodules(592 nodules),including 206 males and 363 females,aged(40.94±3.25)years old,ranging from 15 to 70 years old,they were enrolled in ultrasonics guided fine needle aspiration cytology in department of Ultrasound Medicine of The First People′s Hospital of Xianyang from February 2022 to February 2024.General patient data and ultrasound signs were compared,the value of ACR TI-RADS,C-TIRADS and TBSRTC classification in differentiating benign and malignant thyroid nodules were compared,the receiver operator characteristic(ROC)curves of the 3 classification methods for thyroid nodules were drawn,and the diagnostic efficacy of each classification method were compared.ResultsUsing postoperative histopathology as the"gold standard"for diagnosis,among the 592 nodules,TBSRTC had 226 categoryⅠnodules,categoryⅡnodules were 49,categoryⅢnodules were 70,categoryⅣnodules were 138,categoryⅤnodules were 63 and categoryⅥnodules were 46.A total of 226 TBSRTC categoryⅠnodules in this study were not abnormal or could not be diagnosed,among the other 366 TBSRTCⅡ~Ⅵnodes,including 123 were benign and 243 were malignant.Comparison of age,nodule meridian,nodule size distribution,nodule blood flow distribution,nodule composition,nodule aspect ratio,nodule ratio,nodule margin,nodule echo,nodule calcification characteristics,and TBSRTCⅡtoⅥnodules in patients with benign and malignant nodules,the differences were statistically significant(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and total coincidence rate of ACR TI-RADS in diagnosing benign and malignant thyroi

关 键 词：甲状腺结节 细针穿刺细胞学检查 甲状腺影像报告和数据系统 甲状腺细胞病理学Bethesda报告系统 

分 类 号：R581[医药卫生—内分泌]