摘要
目的 比较6种常用的甲状腺影像报告和数据系统(TI-RADS)单独诊断及联合剪切波弹性成像(SWE)诊断甲状腺结节良恶性的效能,以期为临床决策的制定提供参考。方法 选取2021年3—12月成都医学院第二附属医院·核工业四一六医院收治的甲状腺结节患者230例作为研究对象。根据2011年Kwak提出的Kwak TI-RADS、2015年美国甲状腺协会发布的ATA指南、2016年韩国甲状腺放射学会提出的K-TIRADS、2017年美国放射学会提出的ACR TI-RADS及欧洲甲状腺协会提出的EU TI-RADS、2020年中华医学会提出的C-TIRADS 6种分层系统对结节进行分类并采用SWE进行测量,计算结节恶性率。比较分析6种分层系统单独诊断以及联合SWE诊断甲状腺结节良恶性的效能。结果 230个结节中,良性结节111个(48.3%),恶性结节119个(51.7%)。受试者工作特征(ROC)曲线显示,Kwak TI-RADS、ATA指南、K-TIRADS、ACR TI-RADS、EU TI-RADS、C-TIRADS及SWE的截断值分别为4c类、高度可疑恶性、5级、5类、5类、4c类、47.9 k Pa。C-TIRADS的曲线下面积(AUC)最高,为0.902,与ATA指南、K-TIRADS、EU TI-RADS的AUC之间的差异均有统计学意义(P<0.05)。Kwak TI-RADS、ATA指南、K-TIRADS的敏感度(均为93.3%)最高(P<0.05),C-TIRADS的敏感度(75.6%)最低(P<0.05);C-TIRADS的特异度(91.0%)高于其他几种超声分层系统及SWE(P<0.05)。联合SWE诊断后,6种分层系统中EU TI-RADS敏感度(98.3%)最高,但与其他几种分层系统的敏感度比较,差异均无统计学意义(P>0.05);C-TIRADS的特异度(79.3%)、AUC(0.871)及准确率(87.4%)均高于其他几种分层系统(P<0.05)。相比6种分层系统单独诊断的敏感度,联合SWE诊断后的敏感度均有所增高,其中ACR TI-RADS、EU TI-RADS和C-TIRADS与联合SWE诊断前的敏感度比较,差异均有统计学意义(P<0.05)。此外,C-TIRADS和ACR TI-RADS联合SWE诊断的特异度相比联合前均有所降低(P<0.05)。结论 6种分层系统对甲状腺结节的良恶性均有较好的诊断能力,C-TIRADS特异度最优,联合SWE后,有效提升了诊断敏感度,C-TIRADS联合SWE诊断的AUC、特异度及准确率均高于其他几种分层系统,并且更简易方便、适合中国国情,更适合在国内广泛应用。
Objective This paper aims to compare the efficacy of 6 commonly used Thyroid Imaging Reporting and Data System(TI-RADS)alone or in combination with shear wave elastography(SWE)in the diagnosis of benign and malignant thyroid nodules to provide evidence for clinical decision-making.Methods A total of 230 patients with thyroid nodules admitted to the Second Affiliated Hospital of Chengdu Medical College Nuclear Industry 416 Hospital from March to December 2021 were selected as the study participants.Following the Kwak TI-RADS proposed by Kwak in 2011,ATA guidelines issued by American Thyroid Association in 2015,K-TIRADS proposed by Korean Society of Thyroid Radiology in 2016,ACR TIRADS by American College of Radiology in 2017,EU TI-RADS by European Thyroid Association,C-TIRADS by Chinese Medical Association in 2020,nodules were classified and measured using SWE to calculate the nodule malignancy rate.The efficacy of the six stratification systems alone or in combination with SWE in the diagnosis of beniga and malignant thyroid nodules was compared and analyzed.Results Of the 230 nodules,111(48.3%)were benign and 119(51.7%)were malignant.Receiver operating characteristic(ROC)curves showed that the cutoff values of Kwak TI-RADS,ATA guidelines,K-TIRADS,ACR TI-RADS,EU TI-RADS,C-TIRADS,and SWE were 4c class,highly suspicious malignancy,5 class,5 class,5 class,4c class,and 47.9 kPa,respectively.C-TIRADS had the highest AUC of 0.902,which was significantly different from the AUC of ATA,K-TIRADS,and EU TI-RADS guidelines(P<0.05).The sensitivity of Kwak TI-RADS,ATA guidelines,and KTIRADS(all 93.3%)was the highest(P<0.05),and the sensitivity of C-TIRADS(75.6%)was the lowest(P<0.05);the specificity of C-TIRADS(91.0%)was significantly higher than that of several other ultrasound stratification systems and SWE(P<0.05).After combined SWE diagnosis,the sensitivity of EU TI-RADS(98.3%)was the highest among the six stratification systems,but no significant differences were found in sensitivity compared with the other stratification systems(P>0.05);the specificity,AUC,and accuracy of C-TIRADS was 79.3%,0.871,87.4%,respectively,which were significantly higher than those of the other stratification systems(P<0.05).Compared with the sensitivity of the six stratification systems alone,the sensitivity of combined SWE diagnosis was increased,and there were significant differences in the sensitivity of ACR TI-RADS,EU TI-RADS,and C-TIRADS before combined SWE diagnosis(P<0.05).Besides,the specificity of C-TIRADS and ACR TI-RADS combined with SWE diagnosis was significantly decreased compared with that before combined treatment(P<0.05).Conclusion The six stratification systems show good diagnostic ability for benign and malignant thyroid nodules,and C-TIRADS has the best specificity.After combined SWE diagnosis,the sensitivity is effectively improved.The AUC,specificity,and accuracy of C-TIRADS combined with SWE diagnosis are higher than those of other stratification systems.It is simple,convenient,and suitable for China's national conditions,justifying a wider application in China.
作者
邓楠
曾卓华
贺丹
刘家开
石波
徐可
Deng Nan;Zeng Zhuohua;He Dan;Liu Jiakai;Shi Bo;Xu Ke(Department of Ultrasound,The 2nd Affiliated Hospital of Chengou Medical College Nuclear Industry 416 Hospital,Chengdu 610057,China;Department of Oncology,The 2nd Affiliated Hospital of Chengou Medical College Nuclear Industry 416 Hospital,Chengdu 610057,China)
出处
《保健医学研究与实践》
2023年第9期97-104,共8页
Health Medicine Research and Practice
基金
四川省科技厅科研课题(21YYJC1411)。
