目的:本研究试图比较两种常见的风险分层系统,以评估甲状腺恶性肿瘤的诊断性能。
方法: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)指南在571个甲状腺结节中进行了比较,并进行了明确的细针穿刺(FNA)细胞学检查或术后组织病理学检查。超声特征,如成分,回声,形状,margin,尺寸,评估每个甲状腺结节的血管分布。通过受试者工作特征(ROC)曲线确定和比较诊断性能测量,和决策曲线分析(DCA)。
结果:在571个结节中,65(11.4%)为恶性。AUC,灵敏度,特异性,正预测值,阴性预测值分别为0.691、49.2%,84.9%,29.6%,ATA指南为92.8%,0.776,72.3%,79.2%,30.9%,和95.7%,对于ACRTI-RADS,分别。ACRTI-RADS更敏感(p=0.003),而ATA指南更具特异性(p<0.001)。DCA表明,ACRTI-RADS比ATA指南提供了更大的净收益。此外,ACRTI-RADS的不必要活检净减少量高于ATA指南.与ATA指南相比,ACRTI-RADS的指示活检总数和不必要的FNA率更低(293vs.527和80.2vs.87.8)。ACRTI-RADS在7个恶性结节(全部分类为TR2)中没有活检指征,而ATA指南遗漏了一个。低回声是恶性肿瘤的最重要预测因子(OR=8.34,95%CI:3.75-19.45),其次是高比宽的形状(OR=6.73,95%CI:3.07-14.77)。
结论:我们的研究结果表明,每个系统在评估甲状腺结节方面都有特殊的优势。ACRTI-RADS降低了不必要的FNA速率,然而,使用该系统,分类为TR2的恶性结节可能会被遗漏.建议使用多普勒和其他超声方式进一步评估该组结节。
OBJECTIVE: This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid
malignancy.
METHODS: The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA)
guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).
RESULTS: Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA
guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA
guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of
malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77).
CONCLUSIONS: Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.