不同超声风险分层系统评估甲状腺结节的验证和对比研究

摘要

Objective To verify and compare the TI-RADS developed by Kwak et al .( Kwak TI-RADS ) ,2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer ( ATA Guideline Classification) ,2017 TI-RADS released by the American College of Radiology (ACR TI-RADS) and TI-RADS developed by Zhou et al .(Zhou TI-RADS) in the evaluation of thyroid nodules . Methods The ultrasound images of 339 thyroid nodules in 273 patients were analyzed by retrospective study . The thyroid nodules were categorized into aforementioned four stratified systems . Based on the pathological findings considered the "gold standard",the receiver operating characteristic( ROC ) curve was created to compare the clinical application value of aforementioned four stratified systems . Results The percentage of nodules that could not be categorized were 1 .2％ ,17 .5％ ,0 and 1 .2％ for the Kwak TI-RADS ,ATA guidelines ,ACR TI-RADS ,and Zhou TI-RADS ,respectively and the area under the ROC curve ( AUC) was 0 .899 ,0 .879 ,0 .876 ,and 0 .918 ,respectively . The sensitivity of Kwak TI-RADS ,ATA guidelines classification ,and ACR TI-RADS were higher than that of Zhou TI-RADS (all P < 0 .05) ,whereas the specificity of Zhou TI-RADS was the highest (all P < 0 .05) . As for the accuracy ,no statistically significant differences were observed between any two of Kwak TI-RADS ,ATA guidelines ,ACR TI-RADS ,and Zhou TI-RADS systems ( all P > 0 .05) . Conclusions Four thyroid risk stratification systems provide effective risk assessment for thyroid nodules ,Zhou TI-RADS has relatively lower sensitivity ,but its specificity and AUC value are the highest among the four evaluated systems . In addition ,ACR TI-RADS can classify the most nodules ,while the number of nodules that can′t be categorized by ATA guideline is maximum .%目的 验证和比较Kwak等制定的TI-RADS(Kwak TI-RADS)、2015年美国甲状腺学会 《成人甲状腺结节与分化型甲状腺癌诊治指南》(ATA指南分级)、2017年美国放射学院发布的TI-RADS(ACR TI-RADS)、Zhou等制定的TI-RADS(Zhou TI-RADS)在甲状腺结节评估中的价值.方法 回顾性分析273例患者共339个甲状腺结节的超声图像,用四种分层系统对甲状腺结节进行分类,以病理学结果为"金标准",构建ROC曲线,比较四种分层系统的临床应用价值.结果 Kwak TI-RADS、ATA指南分级、ACR TI-RADS、Zhou TI-RADS不能归类的结节所占的百分比分别为1.2％ 、17.5％ 、0及1.2％;ROC曲线下面积(AUC)分别为0.899、0.879、0.876及0.918.Kwak TI-RADS、ATA指南分级、ACR TI-RADS的敏感性高于Zhou TI-RADS(均P<0.05),然而Zhou TI-RADS的特异性最高(均P<0.05).Kwak TI-RADS、ATA指南分级、ACR TI-RADS、Zhou TI-RADS的准确性两两之间比较差异均无统计学意义(P>0.05).结论 四种甲状腺风险分层系统对甲状腺结节均有良好的风险评估作用,其中Zhou TI-RADS的敏感性相对较低,但Zhou TI-RADS的特异性和AUC最高.此外,ACR TI-RADS能归类的结节最全面,而ATA指南分级不能进行归类的结节最多.