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Abstract：
BACKGROUND Thyroid nodule prevalence reaches 65% in the general population. Hence, appropriate ultrasonic examination is key in disease monitoring and management. We investigated the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) score for diagnosis of benign and malignant thyroid nodules and pathological types. MATERIAL AND METHODS A retrospective study was conducted. According to ultrasound images, ultrasonic characteristics of benign and malignant thyroid nodules and different pathological types were analyzed using ACR-TIRADS score, and diagnostic value was determined. AUCs were compared for tumor diagnosis and differentiation. RESULTS Overall, 1675 thyroid nodules from 1614 patients were included. AUC value of papillary thyroid carcinoma (PTC) diagnosed with ACR-TIRADS was highest (0.955 [95% CI=0.946-0.965]), while that of follicular thyroid carcinoma (FTC) was lowest (0.877 [95% CI=0.843-0.912]). FTC had the highest sensitivity (95.1%) and lowest specificity (64.8%). When the cut-off value was 5.5 points, accuracy of diagnosing PTC and anaplastic thyroid carcinoma (ATC) was highest, 80.5% and 78.7% respectively. Comparison of the multi-index prediction model constructed by multivariable logistic regression analysis and prediction model constructed by ACR-TIRADS score showed, when evaluating PTC and ATC, the multi-index model was better: AUCs of PTC were 0.966 vs 0.955, and AUCs of ATC were 0.982 vs 0.952, respectively, (P<0.05). CONCLUSIONS ACR-TIRADS score-based ultrasound examination of thyroid nodules aids diagnosis of benign and malignant thyroid nodules. TIRADS criteria favor diagnosis of PTC (and ATC) over FTC. ACR-TIRADS score can help clinicians diagnose thyroid nodules quickly and earlier, exhibits good clinical value, and can prevent missed diagnoses.
摘要：
背景技术在一般人群中,甲状腺结节患病率达到65%。因此，适当的超声检查是疾病监测和管理的关键。我们调查了美国放射科甲状腺影像报告和数据系统（ACR-TIRADS）评分，以诊断良性和恶性甲状腺结节以及病理类型。材料与方法回顾性研究。根据超声波图像,采用ACR-TIRADS评分,分析甲状腺良恶性结节的超声特征及不同病理类型,并确定诊断价值。比较AUC的肿瘤诊断和分化。总体结果，纳入1614例患者的1675个甲状腺结节。诊断为ACR-TIRADS的甲状腺乳头状癌(PTC)的AUC值最高(0.955[95%CI=0.946-0.965]),而滤泡性甲状腺癌（FTC）最低（0.877[95%CI=0.843-0.912]）。FTC敏感性最高（95.1%），特异性最低（64.8%）。当截止值为5.5点时，诊断PTC和间变性甲状腺癌（ATC）的准确性最高，分别为80.5%和78.7%。多变量Logistic回归分析构建的多指标预测模型与ACR-TIRADS评分构建的预测模型比较显示,评估PTC和ATC时，多指标模型较好：PTC的AUC分别为0.966和0.955，ATC的AUC分别为0.982和0.952，(P<0.05)。结论基于ACR-TIRADS评分的甲状腺结节超声检查有助于甲状腺结节良恶性的诊断。TIRADS标准比FTC更有利于PTC（和ATC）的诊断。ACR-TIRADS评分可以帮助临床医生快速，更早地诊断甲状腺结节，具有良好的临床价值，并能防止漏诊。
