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Abstract：
This study is aimed at evaluating the diagnostic efficacy and unnecessary fine-needle aspiration (FNA) rate of ultrasound-based risk stratification for thyroid nodules in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) risk stratification systems.
Children and adolescents with pathology confirmed thyroid nodules were retrospectively included in this study. A total of 217 thyroid nodules from multicenter of Union Medical College Hospital, China Japan Friendship Hospital and Civil Aviation Hospital were included, the diagnostic efficiency and unnecessary FNA rate were calculated according to ACR and ATA guidelines.
Among all thyroid nodules, 139 nodules were malignant, and 78 nodules were benign. Choosing ATA high suspicion and ACR TI-RADS TR5 as benign and malignant cut-off points, the area under the curve and sensitivity of ATA were higher than ACR (AUC: 0.887 vs 0.840, p=0.0037; sensitivity 81.3% vs 71.0%, P <0.049;specificity 96.2% vs 97.4%, p=1.000;specificity both 85.9%); choosing high/intermediate suspicion in ATA and ACR TR4/5 as benign and malignant cut-off points, the two guidelines demonstrated similar diagnostic efficacy (AUC:0.890 vs 0.897, p=0.6038, sensitivity 92.1% vs 93.5%, P =0.817;specificity both 85.9%, p=1.000). The inappropriate FNA rate of ACR guideline was relatively lower (ATA 42.9% vs ACR 27.2%, P <0.001). If ACR TI-RADS TR5 nodules less than 1.0cm were included in the FNA indication, the unnecessary biopsy rate would be further reduced to 17.9%.
This study indicated that both ATA and ACR TI-RADS risk stratification systems could provide a feasible differential diagnosis of benign and malignant thyroid nodules, while the ACR risk stratification system demonstrates a lower rate of inappropriate FNA rate. In addition, it was necessary to further study the minimum FNA threshold of thyroid nodules in Children and adolescents in order to reduce the missed biopsy rate of malignant nodules.
Children and adolescents with pathology confirmed thyroid nodules were retrospectively included in this study. A total of 217 thyroid nodules from multicenter of Union Medical College Hospital, China Japan Friendship Hospital and Civil Aviation Hospital were included, the diagnostic efficiency and unnecessary FNA rate were calculated according to ACR and ATA guidelines.
Among all thyroid nodules, 139 nodules were malignant, and 78 nodules were benign. Choosing ATA high suspicion and ACR TI-RADS TR5 as benign and malignant cut-off points, the area under the curve and sensitivity of ATA were higher than ACR (AUC: 0.887 vs 0.840, p=0.0037; sensitivity 81.3% vs 71.0%, P <0.049;specificity 96.2% vs 97.4%, p=1.000;specificity both 85.9%); choosing high/intermediate suspicion in ATA and ACR TR4/5 as benign and malignant cut-off points, the two guidelines demonstrated similar diagnostic efficacy (AUC:0.890 vs 0.897, p=0.6038, sensitivity 92.1% vs 93.5%, P =0.817;specificity both 85.9%, p=1.000). The inappropriate FNA rate of ACR guideline was relatively lower (ATA 42.9% vs ACR 27.2%, P <0.001). If ACR TI-RADS TR5 nodules less than 1.0cm were included in the FNA indication, the unnecessary biopsy rate would be further reduced to 17.9%.
This study indicated that both ATA and ACR TI-RADS risk stratification systems could provide a feasible differential diagnosis of benign and malignant thyroid nodules, while the ACR risk stratification system demonstrates a lower rate of inappropriate FNA rate. In addition, it was necessary to further study the minimum FNA threshold of thyroid nodules in Children and adolescents in order to reduce the missed biopsy rate of malignant nodules.
摘要：
本研究旨在评估美国放射学会（ACR）甲状腺成像报告和数据系统（TI-RADS）和美国甲状腺协会（ATA）风险分层系统中基于超声的甲状腺结节风险分层的诊断效能和不必要的细针穿刺（FNA）率。
本研究回顾性纳入病理证实为甲状腺结节的儿童和青少年。来自协和医院多中心的217个甲状腺结节，包括中日友好医院和民航医院，根据ACR和ATA指南计算诊断效率和不必要的FNA率.
在所有甲状腺结节中，139个结节为恶性，良性结节78个。选择ATA高度怀疑和ACRTI-RADSTR5作为良性和恶性分界点，ATA的曲线下面积和灵敏度均高于ACR（AUC：0.887vs0.840，p=0.0037；灵敏度为81.3％vs71.0％，P<0.049；特异性96.2%vs97.4%，p=1.000；特异性均为85.9％）；在ATA和ACRTR4/5中选择高/中等怀疑作为良性和恶性的截止点，两个指南显示出相似的诊断功效（AUC：0.890vs0.897，p=0.6038，灵敏度92.1％vs93.5％，P=0.817；特异性均为85.9%，p=1.000)。ACR指南的不恰当FNA率相对较低(ATA42.9%vsACR27.2%,P<0.001)。如果FNA指征包括小于1.0cm的ACRTI-RADSTR5结节，不必要的活检率将进一步降低至17.9%。
这项研究表明，ATA和ACRTI-RADS风险分层系统可以为良性和恶性甲状腺结节提供可行的鉴别诊断，而ACR风险分层系统显示FNA不适当率较低。此外,有必要进一步研究儿童和青少年甲状腺结节的最小FNA阈值,以降低恶性结节的活检漏诊率。
本研究回顾性纳入病理证实为甲状腺结节的儿童和青少年。来自协和医院多中心的217个甲状腺结节，包括中日友好医院和民航医院，根据ACR和ATA指南计算诊断效率和不必要的FNA率.
在所有甲状腺结节中，139个结节为恶性，良性结节78个。选择ATA高度怀疑和ACRTI-RADSTR5作为良性和恶性分界点，ATA的曲线下面积和灵敏度均高于ACR（AUC：0.887vs0.840，p=0.0037；灵敏度为81.3％vs71.0％，P<0.049；特异性96.2%vs97.4%，p=1.000；特异性均为85.9％）；在ATA和ACRTR4/5中选择高/中等怀疑作为良性和恶性的截止点，两个指南显示出相似的诊断功效（AUC：0.890vs0.897，p=0.6038，灵敏度92.1％vs93.5％，P=0.817；特异性均为85.9%，p=1.000)。ACR指南的不恰当FNA率相对较低(ATA42.9%vsACR27.2%,P<0.001)。如果FNA指征包括小于1.0cm的ACRTI-RADSTR5结节，不必要的活检率将进一步降低至17.9%。
这项研究表明，ATA和ACRTI-RADS风险分层系统可以为良性和恶性甲状腺结节提供可行的鉴别诊断，而ACR风险分层系统显示FNA不适当率较低。此外,有必要进一步研究儿童和青少年甲状腺结节的最小FNA阈值,以降低恶性结节的活检漏诊率。
