目的:为了利用不同TIRADS的差异,包括ACR-TIRADS,Kwak-TIRADS,C-TIRADS,和欧盟蒂拉兹,探讨提高超声诊断准确率的方法。
方法:总共,包括795个具有细胞学或手术病理的结节。所有结节均由四个TIRADS根据其诊断一致性进行筛查(筛查程序,SP)。将预测变量的判别策略(DS)与SP相结合,构建了评估方法(SPDS)。评估了单独的SPDS方法及其衍生方法和双TIRADS组合测试的诊断性能。
结果:4例TIRADS同时诊断的恶性结节占86.8%(269/310),良性结节占93.6%(365/390)。而12.0%(95/795)的结节不能被它们一致地诊断。DS的标准是等回声性或高回声性结节应被认为是良性的,而低回声性或低回声性结节是恶性的。对于至少两个TIRADS筛查的95个不一致诊断结节,DS表现最好,准确率为79.0%,其次是Kwak-TIRADS(72.6%)。在整个样本中,与四种TIRADS相比,SP+DS方法的灵敏度和AUC最高(91.3%,0.895).与ACR-TIRADS相比,通过并行测试将ACR-TIRADS和Kwak-TIRADS联合使用可显著提高灵敏度和AUC(89.2%vs.81.4%,0.889vs.0.863)。将C-TIRADS和DS组合在一起导致最高的AUC(0.887),其次是Kwak-TIRADS(0.884),而EU-TIRADS最低(0.879)。
结论:对于未确定或疑似甲状腺结节,双TIRADS联合检查可用于提高诊断准确性。否则,考虑到两种TIRADS的诊断不一致,可能需要注意回声特征以区分良性和恶性结节.
结论:•不同TIRADS的诊断性能差异源于它们在诊断不一致的结节上的表现。•ACR-TIRADS通过与Kwak-TIRADS并行组合提高了灵敏度(从81.4%到89.2%),而C-TIRADS通过与EU-TIRADS系列组合增加特异性(从80.9%增加到85.7%)。•如果两个TIRADS的诊断结果不一致,回声特征有助于良恶性结节的鉴别,准确率为79.0%。
OBJECTIVE: To utilize the discrepancies of different
TIRADS, including ACR-
TIRADS, Kwak-
TIRADS, C-
TIRADS, and EU-
TIRADS, to explore methods for improving ultrasound diagnostic accuracy.
METHODS: In total, 795 nodules with cytological or surgical pathology were included. All nodules were screened by the four TIRADS according to their diagnostic concordance (Screening procedures, SP). Discriminant strategy (DS) derived from predictor variables was combined with SP to construct the evaluation method (SP+DS). The diagnostic performance of the SP+DS method alone and its derivational methods and two-TIRADS combined tests was evaluated.
RESULTS: A total of 86.8% (269/310) malignant nodules and 93.6% (365/390) benign cases diagnosed by the four TIRADS simultaneously were pathologically confirmed, while 12.0% (95/795) nodules could not be consistently diagnosed by them. The criteria of DS were that iso- or hyper-echogenicity nodules should be considered benign, while hypo- or marked hypo-echogenicity nodules malignant. For 95 inconsistently diagnosed nodules screened by at least two TIRADS, DS performed best with an accuracy of 79.0%, followed by Kwak-TIRADS (72.6%). In the overall sample, the sensitivity and AUC were highest for the SP+DS method compared to the four TIRADS (91.3%, 0.895). Combining ACR-TIRADS and Kwak-TIRADS via parallel test resulted in significant improvements in the sensitivity and AUC compared to ACR-TIRADS (89.2% vs. 81.4%, 0.889 vs. 0.863). Combining C-
TIRADS and DS in serial resulted in the highest AUC (0.887), followed by Kwak-
TIRADS (0.884), while EU-TIRADS was the lowest (0.879).
CONCLUSIONS: For undetermined or suspected thyroid nodules, two-TIRADS combined tests can be used to improve diagnostic accuracy. Otherwise, considering the inconsistent diagnosis of two TIRADS may require attention to the echo characteristics to differentiate between benign and malignant nodules.
CONCLUSIONS: • The discrepancies in the diagnostic performance of different TIRADS arise from their performance on inconsistently diagnosed nodules. • ACR-TIRADS improves sensitivity via combining with Kwak-
TIRADS in parallel (from 81.4 to 89.2%), while C-
TIRADS increases specificity via combining with EU-
TIRADS in serial (from 80.9 to 85.7%). • If the diagnostic findings of two
TIRADS are inconsistent, echo characteristics will be helpful for the differentiation of benign and malignant nodules with an accuracy of 79.0%.