论著

弹性成像联合ACR-TIRADS诊断甲状腺结节良恶性的临床价值研究

展开
  • a.南京中医药大学附属中西医结合医院 普外科,南京 210028
    b.南京中医药大学附属中西医结合医院 内分泌科,南京 210028
    c.南京中医药大学附属中西医结合医院 超声科,南京 210028

收稿日期: 2018-12-25

  网络出版日期: 2019-06-25

基金资助

江苏省“六大人才高峰”项目(2013-WSN-063);江苏省临床医学科技专项-重点病种的规范化诊疗(BL2013040);中国中医科学院江苏分院院级课题(JSBY1301)

Study on clinical value of ultrasound elastography combined with ACR-TIRADS in differential diagnosis of benign and malignant thyroid nodules

Expand
  • a. Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
    b. Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
    c. Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China

Received date: 2018-12-25

  Online published: 2019-06-25

摘要

目的: 通过回顾性研究分析,比较2017年美国放射学会提出的甲状腺成像报告和数据系统(the Thyroid Imaging Report and Data System recommended by American College of Radiology, ACR-TIRADS)与弹性成像单独或联合诊断在甲状腺结节良恶性鉴别中的临床价值。方法: 选取2012年1月至2017年10月在南京中医药大学附属中西医结合医院就诊的503例甲状腺结节患者,共653个结节。收集患者的一般临床资料、甲状腺超声和弹性成像报告及术后病理,对所有结节采用ACR-TITADS、弹性成像的分级法和评分法进行分级,并总结二者联合的4种方法。方法1,弹性成像与ACR-TIRADS中任一诊断为恶性结节,则判定联合诊断为恶性;方法2,弹性成像与ACR-TIRADS共同诊断为恶性结节,则判定联合诊断为恶性;方法3,弹性成像评分分值与ACR-TIRADS分级结果相加;方法4,弹性成像评分分值与ACR-TIRADS计分分值相加。以术后病理为金标准,构建受试者工作特征曲线,计算曲线下面积(area under the curve, AUC),并根据约登指数选取最佳诊断临界值,比较各方法单独和联合诊断的效能。结果: 随着各诊断方法类别1~4的递增,检出结节的恶性率逐渐增加。ACR-TIRADS诊断甲状腺结节良恶性的AUC有高于弹性超声的趋势,但差异无统计学意义(0.853比0.848,P=0.745)。方法1诊断甲状腺结节良恶性的灵敏度、阴性预测值较高(96.94%、84.85%);方法2的诊断特异度、阳性预测值较高(88.96%、95.53%);方法3的灵敏度高于方法4(88.78%比85.92%,P<0.001);方法4的AUC与方法3之间差异无统计学意义(0.913比0.901,P=0.088)。结论: ACR-TIRADS在甲状腺结节性质诊断中的效能优于弹性成像,而弹性成像评分分值与ACR-TIRADS分级结果相加、弹性成像评分分值与ACR-TIRADS计分分值相加都优于ACR-TIRADS或弹性成像单独诊断,其中方法4在鉴别甲状腺结节良恶性中具有更高的价值。

本文引用格式

季沁, 周一帆, 陈茉, 李杰, 丁文波, 钱涛, 褚晓秋, 王建华, 徐书杭, 刘超 . 弹性成像联合ACR-TIRADS诊断甲状腺结节良恶性的临床价值研究[J]. 诊断学理论与实践, 2019 , 18(03) : 307 -312 . DOI: 10.16150/j.1671-2870.2019.03.012

Abstract

Objective: To analysis retrospectively the value of The Thyroid Imaging Report and Data System recommended by American College of Radiology (ACR-TIRADS) 2017 and ultrasound elastographyalone or in combination for the differential diagnosis of benign and malignant thyroid nodules. Methods: From January 2012 to October 2017, 503 patients with 653 thyroid nodules underwent preoperative thyroid ultrasonography and thyroidectomy at the Integrated Chinese Traditional Medicine and Western Medicine Hospital were enrolled. General clinical information, thyroid ultrasound report, ultrasound elastography and results of postoperative pathology were collected. All the nodules were graded by ACR-TIRADS, elastography grading and scoring system. The four differential diagnostic categories were as follows:category 1, either elastography or ACR-TIRADS considered as malignant nodules; category 2, both elastography and ACR-TIRADS considered as malignant nodules; category 3, elastography score and grade of ACR-TIRADS added; category 4, elastography score and ACR-TIRADS score added. The postoperative pathological results were regarded as a gold standard to construct the receiver operating-characteristic curve (ROC), calculate the area under the curve (AUC), and the best cutoff value was defined according to the Yoden index. Results: The AUC of ACR-TIRADS was as high as that of ultrasound elastography (0.853 vs. 0.848, P=0.745). Category 1 had a differential diagnosis value with higher sensitivity (96.94%) and the negative predictive value (84.85%). The category 2 had a specificity of 88.96% and a positive predictive value of (95.53%). The sensitivity of category 3 was higher than that of category 4 (88.78% vs. 85.92%, P<0.001). There was no statistical difference between AUC of category 3 of category 4.(0.913 vs. 0.901, P=0.088). Conclusions: ACR-TIRADS is superior to ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. Both category 3 and category 4 are superior to ACR-TIRADS or ultrasound elastography alone. The category 4 has a higher discriminatory value in the differential diagnosis of benign and malignant thyroid nodules.

参考文献

[1] 孙可欣, 郑荣寿, 张思维, 等. 2015年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2019, 28(1):1-11.
[2] Xue J, Cao XL, Shi L, et al. The diagnostic value of combination of TI-RADS and ultrasound elastography in the differentiation of benign and malignant thyroid nodu-les[J]. Clin Imaging, 2016 Sep-Oct, 40(5):913-916.
[3] Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee[J]. J Am Coll Radiol, 2017, 14(5):587-595.
[4] Gao L, Xi X, Jiang Y, et al. Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules[J]. Endocrine, 2019, 64(1):90-96.
[5] Xu T, Wu Y, Wu RX, et al. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination[J/OL]. Endocrine. 2018-11-24[2018-12-25]. https://www.ncbi.nlm.nih.gov/pubmed/30474824.
[6] 胡维茜, 黄枢. 超声弹性成像对甲状腺结节良恶性鉴别诊断的应用价值[J]. 临床超声医学杂志, 2016, 18(7):480-482.
[7] 李伟兰, 潘春梅, 高博, 等. 常规超声联合超声弹性成像在甲状腺结节鉴别诊断中的应用[J]. 中华危重症医学杂志(电子版), 2017, 10(3):188-191.
[8] Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis[J]. Radiology, 2006, 239(2):341-350.
[9] Wu XL, Du JR, Wang H, et al. Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines[J/OL]. Endocrine. 2019-03-04[2018-12-25]. https://www.ncbi.nlm.nih.gov/pubmed/30830584.
[10] 张于芝, 徐婷, 顾经宇, 等. 2017美国放射学会甲状腺影像报告和数据系统(ACR-TIRADS)对甲状腺结节鉴别诊断的效能评估[J]. 中华超声影像学杂志, 2018, 27(6):505-509.
[11] 康艺萍, 郭相华, 练锋. 常规超声与超声弹性成像检测甲状腺良恶性肿瘤的临床价值[J]. 中国肿瘤临床与康复, 2019, 26(2): 129-132.
[12] 何翠云. 超声及超声弹性成像在诊断甲状腺良恶性结节中的价值分析[J]. 影像研究与医学应用, 2019, 3(5):91-92.
[13] 赵俊丽, 赵俊峰, 刘瑞霞, 等. 超声TI-RADS分级法和弹性成像技术对甲状腺结节定性诊断的效能比较[J]. 临床超声医学杂志, 2018, 20(4):267-270.
[14] Hang J, Li F, Qiao XH, et al. Combination of Maximum Shear Wave Elasticity Modulus and TIRADS Improves the Diagnostic Specificity in Characterizing Thyroid Nodules: A Retrospective Study[J]. Int J Endocrinol, 2018, 2018:4923050.
[15] Liu Z, Jing H, Han X, et al. Shear wave elastography combined with the thyroid imaging reporting and data system for malignancy risk stratification in thyroid nodu-les[J]. Oncotarget, 2017, 8(26):43406-43416.
[16] Schenke S, Zimny M. Combination of Sonoelastography and TIRADS for the Diagnostic Assessment of Thyroid Nodules[J]. Ultrasound Med Biol, 2018, 44(3):575-583.
[17] 李静, 侯苏芸, 付超, 等. 美国放射学会甲状腺影像报告和数据系统解读与探讨[J]. 中华超声影像学杂志, 2018, 27(2):180-184.
文章导航

/