■对比增强超声甲状腺成像报告和数据系统(CEUSTI-RADS)是第一个基于常规超声(US)和CEUS的甲状腺结节国际风险分层系统。本研究旨在评估CEUSTI-RADS对良恶性甲状腺结节的诊断效能,并评估相关观察者之间的一致性。
■该研究招募了2019年1月至2023年6月在广东医科大学附属医院接受甲状腺US和CEUS检查的433例患者。回顾性分析通过细针穿刺(FNA)和/或手术证实的467个甲状腺结节。Further,根据结节US和CEUS特征的CEUSTI-RADS评分标准,对每个甲状腺结节进行CEUSTI-RADS分类.结节根据其大小分组如下:大小≤1厘米,A组;尺寸>1且≤4厘米,B组;尺寸>4厘米,采用多因素logistic回归分析甲状腺恶性结节的独立危险因素。病理评估是建立敏感性(SEN)的参考标准,特异性(SPE),精度(ACC),阳性预测值(PPV),CEUSTI-RADS诊断甲状腺恶性结节的阴性预测值(NPV)。采用受试者工作特征(ROC)曲线分析中的曲线下面积(AUC)比较评分系统对3组结节恶性程度的预测效能。采用组内相关系数(ICC)评估CEUSTI-RADS评分的观察者之间的一致性。
■在467个甲状腺结节中,262例为恶性,205例为良性。Logistic回归分析显示,甲状腺结节的独立危险因素包括点状回声灶(P<0.001),高的比宽的形状(P=0.015),甲状腺外侵入(P=0.020),不规则边缘/分叶(P=0.036),美国的低回声(P=0.038),CEUS增强不足(P<0.001)。CEUSTI-RADS诊断甲状腺恶性结节的AUC为0.898,A组0.795,B组0.949,C组0.801,CEUSTI-RADS的最佳截止值为5点,6分,5分,5分,分别。在这些结节组中,B组AUC最高,与SEN,SPE,ACC,PPV,诊断恶性结节的NPV为95.9%,88.1%,92.8%,92.6%,和93.2%,分别。高级和初级医师的CEUSTI-RADS分类ICC为0.862(P<0.001)。
■总之,CEUSTI-RADS在区分甲状腺结节方面显示出明显的疗效。尽管如此,它检测不同大小的恶性结节的能力存在差异,它在1至4厘米的结节中表现出最佳性能。这些发现可能是临床诊断的重要见解。
UNASSIGNED: The contrasted-enhanced ultrasound thyroid imaging reporting and data system (CEUS TI-RADS) is the first international risk stratification system for thyroid nodules based on conventional ultrasound (US) and CEUS. This study aimed to evaluate the diagnostic efficacy of CEUS TI-RADS for benign and malignant thyroid nodules and to assess the related interobserver agreement.
UNASSIGNED: The study recruited 433 patients who underwent thyroid US and CEUS between January 2019 and June 2023 at the Affiliated Hospital of Guangdong Medical University. A retrospective analysis of 467 thyroid nodules confirmed by fine-needle aspiration (FNA) and/or surgery was performed. Further, a CEUS TI-RADS classification was assigned to each thyroid nodule based on the CEUS TI-RADS scoring criteria for the US and CEUS features of the nodule. The nodules were grouped based on their sizes as follows: size ≤1 cm, group A; size >1 and ≤4 cm, group B; and size >4 cm, group C. Multivariate logistic regression was used to analyze independent risk factors for malignant thyroid nodules. Pathological assessment was the reference standard for establishing the sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) of CEUS TI-RADS in diagnosing malignant thyroid nodules. The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of the scoring system in predicting malignancy in three groups of nodules. The intragroup correlation coefficient (ICC) was adopted to assess the interobserver agreement of the CEUS TI-RADS score.
UNASSIGNED: Out of the 467 thyroid nodules, 262 were malignant and 205 were benign. Logistic regression analysis revealed that the independent risk factors for malignant thyroid nodules included punctate echogenic foci (P<0.001), taller-than-wide shape (P=0.015), extrathyroidal invasion (P=0.020), irregular margins/lobulation (P=0.036), hypoechoicity on US (P=0.038), and hypoenhancement on CEUS (P<0.001). The AUC for the CEUS TI-RADS in diagnosing malignant thyroid nodules was 0.898 for all nodules, 0.795 for group A, 0.949 for group B, and 0.801 for group C, with the optimal cutoff values of the CEUS TI-RADS being 5 points, 6 points, 5 points, and 5 points, respectively. Among these groups of nodules, group B had the highest AUC, with the SEN, SPE, ACC, PPV, and NPV for diagnosing malignant nodules being 95.9%, 88.1%, 92.8%, 92.6%, and 93.2%, respectively. The ICC of the CEUS TI-RADS classification between senior and junior physicians was 0.862 (P<0.001).
UNASSIGNED: In summary, CEUS TI-RADS demonstrated significant efficacy in distinguishing thyroid nodules. Nonetheless, there were variations in its capacity to detect malignant nodules across diverse sizes, and it demonstrate optimal performance in 1- to 4-cm nodules. These findings may serve as important insights for clinical diagnoses.