目的:探讨目前使用的基于超声的甲状腺结节风险分层系统的诊断性能(K-TIRADS,ACR-轮胎,和C-TIRADS)可区分滤泡性甲状腺腺瘤(FTA)和滤泡性甲状腺癌(FTC)。
方法:回顾性分析269例甲状腺滤泡性肿瘤的临床资料及术前超声图像。所有这些都是通过配备高频衬垫阵列探头的彩色多普勒超声仪器检测到的(例如L5-14MHZ的东芝Apoli500;L5-12MHZ的飞利浦IU22;L9-12MHZ的GELOGIQE9和L9-14MHZ的MyLabC类)。通过绘制接收器工作特性(ROC)曲线并计算临界值,评估了三种TIRADS分类将FTA与FTC区分开的诊断性能。
结果:在269个滤泡性肿瘤中(平均大小,3.67±1.53cm),209是自由贸易协定(平均规模,3.56±1.38厘米)和60厘米是FTC(平均大小,4.07±1.93cm)。有显著差异的超声特征,如边缘,钙化,FTA组和FTC组之间甲状腺结节的血管分布(P<0.05)。根据ROC曲线对比分析,K-TIRADS的诊断截止值,ACR-TIRADS,鉴定FTA和FTC的C-TIRADS是K-TR4,ACR-TR4和C-TR4B,分别,曲线下面积分别为0.676、0.728和0.719。ACR-TIRADS和K-TIRADS分类之间的差异有统计学意义(P=0.0241)。而ACR-TIRADS和C-TIRADS分类之间以及K-TIRADS和C-TIRADS分类之间的差异无统计学意义(P>0.05)。
结论:三种TIRADS分类不利于区分FTA和FTC。有必要开发一种新型的恶性风险分层系统,专门用于识别滤泡性甲状腺肿瘤。
OBJECTIVE: To explore the diagnostic performance of the currently used ultrasound-based thyroid nodule risk stratification systems (K-TIRADS, ACR -TIRADS, and C-TIRADS) in differentiating follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC).
METHODS: Clinical data and preoperative ultrasonographic images of 269 follicular thyroid neoplasms were retrospectively analyzed. All of them were detected by Color Doppler ultrasound instruments equipped with high-frequency liner array probes (e.g. Toshiba Apoli500 with L5-14MHZ; Philips IU22 with L5-12MHZ; GE LOGIQ E9 with L9-12MHZ and MyLab Class C with L9-14MHZ). The diagnostic performance of three TIRADS classifications for differentiating FTA from FTC was evaluated by drawing the receiver operating characteristic (ROC) curves and calculating the cut-off values.
RESULTS: Of the 269 follicular neoplasms (mean size, 3.67±1.53 cm), 209 were FTAs (mean size, 3.56±1.38 cm) and 60 were FTCs (mean size, 4.07±1.93 cm). There were significant differences in ultrasound features such as margins, calcifications, and vascularity of thyroid nodules between the FTA and FTC groups (P < 0.05). According to the ROC curve comparison analysis, the diagnostic cut-off values of K-TIRADS, ACR-TIRADS, and C-TIRADS for identifying FTA and FTC were K-TR4, ACR-TR4, and C-TR4B, respectively, and the areas under the curves were 0.676, 0.728, and 0.719, respectively. The difference between ACR-TIRADS and K-TIRADS classification was statistically significant (P = 0.0241), whereas the differences between ACR-TIRADS and C-TIRADS classification and between K-TIRADS and C-TIRADS classification were not statistically significant (P > 0.05).
CONCLUSIONS: The three TIRADS classifications were not conducive to distinguishing FTA from FTC. It is necessary to develop a novel malignant risk stratification system specifically for the identification of follicular thyroid neoplasms.