目的： 分析瑞金甲状腺影像报告与数据系统（Ruijin-thyroid imaging reporting and data system,RJ-TIRADS）联合细针穿刺活检（fine-needle aspiration biopsy, FNAB）在老年甲状腺结节患者中的诊断价值。方法： 2017年4月至2020年4月,选取在安徽省宿州市立医院超声科和上海交通大学医学院附属瑞金医院超声科检查并行FNAB及手术治疗的甲状腺结节病例,共纳入117例≥60岁的患者,其中男性30例,女性87例,共129个结节,98个为恶性结节,31个为良性结节。对患者所有结节的超声图像进行分析,观察并记录结节的大小、内部结构、回声、形态、边缘、钙化灶。采用RJ-TIRADS分类方法（计数版）,0个恶性特征评为3类,1个恶性特征评为4A类,2个恶性特征评为4B类,3~4个恶性特征评为4C类,5个恶性特征评为5类。以术后组织病理诊断为金标准,计算老年患者中RJ-TITADS及FNAB单独或联合诊断甲状腺癌的灵敏度、特异度、阳性预测值、阴性预测值和准确率。结果： 实性的超声特征在男性和女性甲状腺癌患者中分别占91.7%和100%,差异有统计学意义（P<0.05）;RJ-TIRADS分类结果显示,老年患者中4A~4C类结节的恶性风险（59.3%、88.4%、100%）高于整体人群中4A~4C类结节的恶性风险（5.0%~20.0%、21.0%~50.0%、51.0%~90.0%）（P<0.05）;FNAB诊断甲状腺癌的灵敏度、特异度、准确率分别为99.0%、83.9%和95.3%,高于实性、低回声、纵横比>1、边缘不光整、微钙化这5个可疑恶性超声特征的诊断价值;FNAB联合RJ-TIRADS可将≥RJ-TIRADS 4A结节的诊断特异度、准确率从29.0%、82.9%提高到87.1%、96.9%。结论： 老年甲状腺癌患者中,女性患者出现实性结节多于男性;老年患者中RJ-TIRADS（计数版）4类结节的恶性风险较整体人群升高;FNAB联合RJ-TIRADS可提高甲状腺结节的超声诊断效能。

Objective: To evaluate diagnostic value of Ruijin-thyroid imaging reporting and datasystem (RJ-TIRADS) combining with fine needle aspiration biopsy(FNAB) in thyroid nodules in elderly patients. Methods: From April 2017 to April 2020, a total of 117 patients (≥60 years old, 30 male and 87 female) with 129 thyroid nodules were enrolled from Department of Ultrasound,Suzhou Hospital Affiliated to Anhui Medical University and Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All the patients were performed with ultrasound-guided FNAB and surgical treatment. Postoperative pathological diagnosis confirmed that 98 lesions were malignant and 31 were benign in all 129 thyroid nodules form patients. The data including size, internal structure, echo, morphology, margin and calcification of nodules on ultrasound imaging was collected and analyzed. Thyroid nodules were classified into three categories according to RJ-TIRADS classification as follows: Nodules without malignant characteristic(MC) were classified as category 3, nodules with one MC were classified as category 4A, nodules with 2 MC were classified as category 4B, nodules with 3-4 MC were classified as category 4C, nodules with 5 MC were classified as category 5. The diagnostic sensitivity,specificity, positive predictive value,negative predictive value and accuracy of RJ-TIRADS and FNAB alone or combination for malignant thyroid nodules in elderly patients were calculated regarding to the results of pathological biopsy. Results: There were significant differences between male and female patients with thyroid cancer in terms of solid (91.7% and 100%) lesions(P<0.05). The RJ-TIRADS classification results showed that cancer risk for patients with the category 4A-4C（59.3%, 88.4%, 100%） in elderly patients was higher than that in the general population（5.0%-20.0%, 21.0%-50.0%, 51.0%-90.0%）. The sensitivity, specificity and accuracy of FNAB in diagnosing thyroid nodules were 99.0%, 83.9% and 95.3%, higher respectively than ultrasound malignant characteristics, such as solid, low echo, aspect ratio of nodules >1, irregular margin, micro-calcification. Specificity and accuracy of FNAB in combination with RJ-TIRADS increased from 29%, 82.9% to 87.1%, 96.9% respectively. Conclusions: Solid nodules more often occur in the elderly female with thyroid cancer than male with thyroid cancer. Compared to the general population with RJ-TIRADS category 4, elderly patients classified as RJ-TIRADS category 4 have a higher risk of having thyroid cancer. FNAB combined with RJ-TIRADS may increase diagnosis value of thyroid nodules in the elderly.