标题：3种TI-RADS分类系统在甲状腺结节良恶性诊断中的应用价值

      作者：周伟 1，单东礼 2，冯凡 1，程瑶 2    周伟 1，单东礼 2，冯凡 1，程瑶 21.安康市中心医院超声科，陕西 安康 725000；2.安康市妇幼保健院超声科，陕西 安康 725000

      卷次： 2023年34卷24期

      【摘要】 目的 研究 3种甲状腺影像报告与数据系统(TI-RADS)在甲状腺结节良恶性诊断中的应用价值。方法 回顾性分析2020年3月至2023年2月安康市中心医院收治的120例患者136个甲状腺结节的病理及超声资料，依据术后病理结果，计算2017年美国放射学会甲状腺影像报告与数据系统(ACR-TIRADS)、欧洲甲状腺协会发布甲状腺影像报告与数据系统(EU-TIRADS)、甲状腺结节超声恶性危险分层中国指南C-TIRADS中不同分类的恶性百分比及其与分类系统的相关性(使用Spearman相关分析)，并绘制受试者工作特征曲线(ROC)曲线，比较3种 T分类系统对甲状腺结节良恶性诊断的最佳截断值、曲线下面积(AUC)、诊断效能及细针穿刺活检(FNA)推荐个数。结果 ACR-TIRADS 1、2、3、4、5类恶性比率分别为0、0、0、20.00%、81.97%，EU-TIRADS 2、3、4、5类恶性比率分别为 0、0、20.00%、79.53%，C-TIRADS 2、3、4A、4B、4C、5类恶性比率分别为 0、0、25.00%、33.33%、82.95%、95.83%，相同TI-RADS系统各分类间的恶性比率比较差异均有统计学意义(P<0.05)；ACR-TIRADS、EU-TIRADS、C-TIRADS分类与恶性比率呈正相关(r=0.90、0.96、0.99，P<0.05)；ACR-TIRADS、EU-TIRADS及C-TIRADS诊断恶性甲状腺结节的曲线下面积(AUC)值分别为0.668、0.613、0.780，其中C-TIRADS的AUC明显高于ACR-TIRADS与EU-TIRADS，差异均有统计学意义(P<0.05)；ACR-TIRADS、EU-TIRADS及C-TIRADS诊断恶性甲状腺结节的最佳截断值分别为5类、5类和4C类；C-TIRADS诊断恶性甲状腺结节的准确性、特异性分别为83.82%、52.94%，明显高于ACR-TIRADS的82.35%、35.29%及EU-TIRADS的80.15%、23.53%，差异均有统计学意义(P<0.05)；3种TI-RADS分类系统诊断恶性甲状腺结节的敏感性比较差异无统计学意义(P>0.05)；ACR-TIRADS及C-TIRADS分类系统FNA推荐个数分别为 70个、66个，明显少于EU-TIRADS的 129个，差异均有统计学意义(P<0.05)；3种分类系统FNA推荐数中，病理恶性检出率比较差异无统计学意义(P>0.05)。结论 在甲状腺结节良恶性诊断中，相比于ACR-TIRADS、EU-TIRADS分类系统，C-TIRADS的诊断效能最高，其诊断最佳临界值4C，但是三者在FNA推荐数病理恶性检出率方面无明显差异。
      【关键词】 甲状腺结节；良恶性；甲状腺影像报告与数据系统；诊断效能；细针穿刺活检
      【中图分类号】 R581 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3608—06

Application value of three TI-RADS classification systems in the diagnosis of benign and malignant thyroidnodules.
ZHOU Wei 1, DAN Dong-li 2, FENG Fan 1, CHENG Yao 2. 1. Department of Ultrasound, Ankang Central Hospital,Ankang 725000, Shaanxi, CHINA; 2. Department of Ultrasound, Ankang Maternal and Child Health Hospital, Ankang725000, Shaanxi, CHINA
【Abstract】 Objective To investigate the application value of three Thyroid Image Report and Data System(TI-RADS) classification systems in the diagnosis of benign and malignant thyroid nodules. Methods Pathological andultrasonic data of 136 thyroid nodules in 120 patients admitted to Ankang Central Hospital from March 2020 to February2023 were retrospectively analyzed. According to postoperative pathological results, the malignant percentages of differ-ent classifications of Thyroid Imaging Reporting and Data System by the American College of Radiology (ACR-TI-RADS), the Thyroid Imaging Reporting and Data System by European Thyroid Association (EU-TIRADS), and ChineseGuidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules (C-TIRADS) were calculated, and theircorrelation with the classification system was analyzed using Spearman correlation. Receiver operating characteristic(ROC) curve were drawn to compare the best cutoff value, area under the curve (AUC), diagnostic efficiency, and recom-mended number of fine needle biopsy (FNA) in the diagnosis of benign and malignant thyroid nodules by threeTI-RADS classification systems. Results The malignant rates of ACR-TIRADS 1, 2, 3, 4, and 5 were 0, 0, 0, 20.00%,and 81.97%, those of EU-TIRADS 2, 3, 4, and 5 were 0, 0, 20.00%, and 79.53%, and the malignant rates of C-TIRADS2, 3, 4A, 4B, 4C, and 5 categories were 0, 0, 25.00%, 33.33%, 82.95%, and 95.83%; the malignant rates among differentgrades of the same TI-RADS system were statistically significant (P<0.05). ACR-TIRADS, EU-TIRADS, and C-TI-RADS were positively correlated with the malignant rate (r=0.90, 0.96, 0.99; P<0.05). The area under the curve (AUC)values of ACR-TIRADS, EU-TIRADS, and C-TIRADS in the diagnosis of malignant thyroid nodules were 0.668, 0.613,and 0.780, and the AUC values of C-TIRADS were significantly higher than those of ACR-TIRADS and EU-TIRADS(P<0.05). The best truncation values of ACR-TIRADS, EU-TIRADS, and C-TIRADS in the diagnosis of malignant thy-roid nodules were category 5, category 5, and category 4C, and the accuracy and specificity of C-TIRADS in the diagno-sis of malignant thyroid nodules were 83.82% and 52.94%, which were significantly higher than 82.35% and 35.29% ofACR-TIRADS and 80.15% and 23.53% of EU-TIRADS (P<0.05). There was no significant difference in the sensitivityamong the three TI-RADS classification systems in the diagnosis of malignant thyroid nodules (P>0.05). The recommend-ed number of FNAs for ACR-TIRADS and C-TIRADS were 70 and 66, significantly less than 129 for EU-TIRADS (P<0.05). There were no significant difference in the detection rate of pathological malignancy among the recommended num-ber of FNA in ACR-TIRADS, EU-TIRADS and C-TIRADS classification system (P>0.05). Conclusion In the diagno-sis of benign and malignant thyroid nodules, compared with ACR-TIRADS and EU-TIRADS classification system, C-TI-RADS had the highest diagnostic efficacy, with the optimal diagnostic threshold of 4C. But there was no significant dif-ference in the detection rate of pathological malignancy of the recommended number of FNA.
      【Key words】 Thyroid nodule; Benign and malignant; Thyroid Imaging Reporting and Data System; Diagnosticeffectiveness; Fine needle aspiration biopsy