C-TIRADS与ACR TIRADS对判断甲状腺结节良恶性的诊断效能比较

Comparison of the diagnostic efficacy of C-TIRADS and ACR TIRADS for benign and malignant thyroid nodules

摘要:

目的： 比较中华医学会超声医学分会甲状腺影像报告和数据系统（C-TIRADS）与美国放射学会甲状腺影像报告和数据系统（ACR TIRADS）对甲状腺结节良恶性的诊断效能。方法： 回顾性分析321枚行甲状腺细针穿刺的甲状腺结节，统计穿刺后结节声像图资料，使用C-TIRADS指南、ACR TIRADS指南进行结节再次评估，构建二者的受试者工作特征（receiver operating characteristic，ROC）曲线，计算二者灵敏度、特异度、准确度，比较二者在甲状腺结节诊断中的效能。结果： C-TIRADS指南甲状腺结节恶性风险为：2类0.0%（0/10），3类5.0%（1/20），4a类17.3%（22/127），4b类44.3%（43/97），4c类74.4%（32/43），5类91.7%（22/24）；ACR TIRADS指南为：2类4.3%（1/22），3类3.4%（2/58），4类35.9%（52/145），5类64.6%（62/96）。C-TIRADS指南和ACR TIRADS指南的曲线下面积（area under the curve，AUC）分别为0.798（95%CI=0.749~0.840）、0.765（95%CI=0.715~0.810），二者差异无统计学意义（P=0.081），约登指数最大值分别为0.467、0.382，对应的最佳截断值分别为C-TIRADS4a、ACR-TIRADS 4类；C-TIRADS的灵敏度、特异度、准确度分别为81.82%、84.00%、83.18%，ACR TIRADS的灵敏度、特异度、准确度分别为81.82%、60.00%、68.22%，C-TIRADS较ACR TIRADS特异度、准确度更高，差异有统计学意义（P=0.000，P=0.000），二者灵敏度差异无统计学意义（P=1.000）。结论： C-TIRADS较ACR TIRADS在甲状腺结节诊断中具有更高的特异度和准确度。

Abstract:

Objective: To compare the diagnostic efficacy of C-TIRADS and ACR TIRADS for benign and malignant thyroid nodules. Methods: A retrospective analysis was performed on 321 thyroid nodules undergoing fine needle aspiration. The data of ultrasonographic image were collected. Ultrasonic physicians re-graded all nodules by C-TIRADS guideline and ACR TIRADS guideline. The receiver operating characteristic (ROC) curve of them was constructed, and the sensitivity, specificity and accuracy of C-TIRADS and ACR TIRADS were calculated and their diagnostic efficacy for thyroid nodules were compared. Results: By C-TIRADS guideline, the risks of malignant thyroid nodules were as follows: 0.0% (0/10) in category 2, 5.0% (1/20) in category 3, 17.3% (22/127) in category 4a, 44.3% (43/97) in category 4b, 74.4% (32/43) in category 4c, and 91.7% (22/24) in category 5. By ACR TIRADS: 4.3% (1/22) in category 2, 3.4% (2/58) in category 3, 35.9% (52/145) in category 4, and 64.6% (62/96) in category 5. The area under curve (AUC) of C-TIRADS and ACR TIRADS were 0.798 (95%CI=0.749–0.840) and 0.765 (95%CI=0.715–0.810) , respectively, without statistically significant difference (P=0.081) . The maximum value of the Youden index was 0.467 and 0.382, and the corresponding cutoff values were C-TIRADS 4a and ACR-TIRADS 4, respectively. The sensitivity, specificity and accuracy of C-TIRADS were 81.82%, 84.00%and 83.18%, respectively, and those of ACR TIRADS were 81.82%, 60.00%and 68.22%respectively. The specificity and accuracy of C-TIRADS were higher than those of ACR TIRADS, and the difference was statistically significant (P=0.000, P=0.000) , but there was no statistically significant difference in sensitivity (P=1.000) . Conclusion: C-TIRADS has better specificity and accuracy than ACR TIRADS in diagnosis of thyroid nodules.