四种甲状腺影像报告与数据系统对BethesdaⅠ和Ⅲ类甲状腺结节的风险评估价值  

Risk assessment value of four thyroid imaging reporting and data systems for BethesdaⅠandⅢthyroid nodules

作　　者：曾微单 李艾樾 赵丽娜 曹红娟 李莎 周恬 付蕾 廖春雁 赵悦瑶 黄权丰 范玉冰 袁瑶 王星 黄富琴 张蓓 ZENG Weidan;LI Aiyue;ZHAO Li'na;CAO Hongjuan;LI Sha;ZHOU Tian;FU Lei;LIAO Chunyan;ZHAO Yueyao;HUANG Quanfeng;FAN Yubing;YUAN Yao;WANG Xing;HUANG Fuqin;ZHANG Bei(Ultrasound Centre,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Medical Imaging,Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Breast Surgery,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院超声中心,贵州贵阳550004 [2]贵州医科大学医学影像学院,贵州贵阳550004 [3]贵州医科大学附属医院乳腺外科,贵州贵阳550004

出　　处：《贵州医科大学学报》2025年第4期606-612,共7页Journal of Guizhou Medical University

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2021-170)。

摘　　要：目的探讨我国常用的四种甲状腺影像报告与数据系统((thyroid imaging reporting and data system,TI-RADS)对超声引导下细针穿刺活检术(ultrasound-guided fine needle aspiration biopsy,US-FNAB)结果为BethesdaⅠ、Ⅲ类甲状腺结节(thyroid nodules,TN)的风险评估价值。方法选取170例US-FNAB细胞学分类为BethesdaⅠ、Ⅲ类TN患者为研究对象,根据TN切除术后病理结果分为良性组(n=66)、恶性组(n=104);比较2组患者的一般资料及结节超声特征,将单因素分析有意义的指标进行多因素Logistic回归分析,得到恶性结节的独立危险因素;根据ATA指南、ACR TI-RADS、Kwak TI-RADS及C-TIRADS四种TI-RADS对两组患者TN分别进行分类,以病理结果为金标准,绘制受试者工作特性(receiver operating characteristic curve,ROC)曲线,比较四种TI-RADS的诊断效能。结果2组患者的一般资料中年龄、超声特征中结节最大径、纵横比、形态、边界、结构的比较差异有统计学意义(P<0.05);多因素logistic回归分析显示患者年龄较小、结节最大径<10 mm、纵横比>1、边界不清为BethesdaⅠ、Ⅲ类恶性结节的独立危险因素(OR=0.956、4.462、5.399、4.419,均P<0.05);四种超声危险系统最佳诊断值分别为ATA高度可疑恶性、Kwak TI-RADS 5类、ACR TI-RADS 5类、C-TIRADS 4c类,其中C-TIRADS的ROC曲线下面积(areas under the curve,AUC)高于其他三种分类系统(AUC=0.838,P<0.05)。结论患者年龄偏小、超声表现结节最大径<10 mm、纵横比>1、边界不清为BethesdaⅠ、Ⅲ类恶性结节的独立危险因素,四种我国常用的超声危险分类系统中C-TIRADS诊断效能优于其他三种。Objective To investigate the risk assessment value of four thyroid imaging reporting and data systems(TI-RADS)commonly used in China for ultrasound-guided fine needle aspiration biopsy(US-FNAB)results of BethesdaⅠandⅢthyroid nodules(TN).Methods A total of 170 patients with BethesdaⅠandⅢTN classified by US-FNAB cytology were selected as participants of the study.Based on the pathological results of TN after resection,the participants were divided into benign group(n=66)and malignant group(n=104).The general data and ultrasonic characteristics of nodules of patients in the two groups were compared and the meaningful indexes of single factor analysis were examined by multifactorial logistic regression analysis to obtain the independent risk factors of malignant nodules.According to the ATA guidelines,ACR TI-RADS,Kwak TI-RADS,and C-TIRADS,the TN of the two groups of patients were classified respectively,and the pathological results were used as the gold standard.The receiver operating characteristic curve(ROC)curve was drawn to compare the diagnostic efficacy of the four TI-RADS.Results Statistically significant differences(P<0.05)were identified in the general data of patients in the two groups in terms of age,nodules maximum diameter,aspect ratio,morphology,border and structure.Multifactorial logistic regression analysis showed that younger age of the patients,nodules maximum diameter<10 mm,aspect ratio>1,and unclear borders were the independent risk factors for BethesdaⅠandⅢmalignant nodules(OR=0.956,4.462,5.399,and 4.419;all P<0.05).The best diagnostic values of the four ultrasound risk systems were ATA highly suspicious of malignancy,Kwak TI-RADS category 5,ACR TI-RADS category 5,and C-TIRADS category 4c,respectively.The area under the ROC curve(AUC)of C-TIRADS was higher than that of the other three classification systems(AUC=0.838,P<0.05).Conclusion The independent risk factors of BethesdaⅠandⅢmalignant nodules are younger ages of patients,nodules maximum diameter<10 mm,aspect ratio>1,and uncle

关 键 词：超声 甲状腺影像报告与数据系统 甲状腺结节BethesdaⅠ类 BethesdaⅢ类 良恶性 

分 类 号：R445.1[医药卫生—影像医学与核医学]