美国放射学会甲状腺结节影像报告系统和影像偶发甲状腺结节管理系列白皮书解读

摘要

Thyroid nodules are common diseases in neck. As the most commonly used imaging technique for the evaluation of thyroid nodules, ultrasound has a high accuracy of differentiating malignant from benign thyroid nodules. However, there are inter-observer variabilities in the diagnosis and description of thyroid nodules by ultrasound. And terms used to describe nodules are often poorly defined, which is the major cause of inter-observer variabilities. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TI-RADS), modeled on the BI-RADS system for breast imaging. And then they recommended corresponding fine-needle aspiration (FNA) or follow-up according to risk stratification. Despite these efforts, none of these TIRADS classifications have been widely adopted. With the widely use of high-quality imaging, incidental thyroid nodules (ITNs), which are defined as nodules not previously detected or suspected clinically, are increasingly prevalent. Most ITNs are small and benign. And incidental thyroid malignancies typically have indolent behavior. There is no unified standard for clinical management of ITNs by now. As a result, American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee and ACR TI-RADS Committee. They published "Managing ITNs Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee", "Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR TIRADS Committee" and "ACR TI-RADS: White Paper of the ACR TI-RADS Committee" from 2015 to 2017. Through establishing these white papers, ACR tried to provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance, standardize the diagnostic approach to thyroid nodules through the development of a lexicon and recommend a practical approach to managing ITNs on CT, MRI, nuclear medicine and ultrasound studies.%甲状腺结节是颈部常见疾病,超声作为甲状腺结节的首选检查方式,诊断率较高,但存在观察者依赖性,其中超声成像特征判断及描述定义不一,是一致性较差的主要原因.对应乳腺影像报告及数据系统(Breast Imaging,Reporting and Data System,BI-RADS),一些学者提出了甲状腺影像报告及数据系统 (Thyroid Imaging,Reporting and Data System,TI-RADS),部分推荐了进一步随访或细针穿刺活检(fine-needle aspiration,FNA)方案,但版本较多,均未被广泛使用.随着高质量影像学诊断方法的广泛应用,影像偶发甲状腺结节(incidental thyroid nodules,ITNs)(即:临床未发现或未怀疑,由影像检查偶然发现的甲状腺结节)临床愈来愈常见,多数体积较小,为良性病变,其中恶性结节的生物学行为多具有惰性特征,其临床管理尚缺乏统一的规范标准.针对以上情况,美国放射学会(American College of Radiology,ACR)成立了ACR TI-RADS委员会和ACR甲状腺偶发结节委员会,于2015—2017年顺序发表了《影像偶发甲状腺结节管理:ACR偶发甲状腺结节委员会白皮书》《甲状腺超声报告词典:ACR TI-RADS委员会白皮书》《ACR甲状腺影像报告和数据系统: ACR TI-RADS委员会白皮书》.尝试通过系列白皮书建立基于甲状腺结节特征的规范化标准化评估系统即ACR TI-RADS体系,并且提出对CT、MRI、核医学以及超声探查到的ITNs进行实际有效管理规范的建议.