C-TIRADS与ACR-TIRADS赋分系统对甲状腺滤泡状癌的诊断价值比较-现代医学

C-TIRADS与ACR-TIRADS赋分系统对甲状腺滤泡状癌的诊断价值比较

单位：1. 东南大学医院超声科, 江苏南京 210018;
2. 南京中医药大学附属中西医结合医院超声科, 江苏南京 210028;
3. 南京中医药大学附属中西医结合医院病理科, 江苏南京 210028;
4. 东南大学医院康复科, 江苏南京 210018

关键词：甲状腺滤泡状癌风险分层赋分系统诊断

分类号：R445.1

出版年·卷·期（页码）：2023·51·第十二期（1757-1762）

摘要：

目的：比较中华医学会超声医学分会和ACR(美国放射学会)的两套甲状腺影像报告和数据系统C-TIRADS和ACR-TIRADS，探讨两者对起源于甲状腺滤泡上皮的甲状腺滤泡状癌(FTC)的诊断价值。方法：回顾性分析甲状腺根治术病理证实为FTC的37个结节(FTC组)，并选择同样起源于滤泡上皮的滤泡腺瘤(FA)93个结节作为对照(FA组)，比较两组患者的性别、年龄和结节位置的差异。以结节最大径≥2.05 cm为阳性标准比较C-TIRADS与ACR-TIRADS各自评分细则在FTC组和FA组的差异，并对比两个系统对FTC的诊断效能。结果：患者性别、年龄、结节位置、实性、形态不规则、强回声等超声特征在两组间比较差异均无统计学意义(P>0.05)，而结节最大径增大、低回声、边缘不规则/甲状腺外侵犯等超声特征在两组中差异具有统计学意义(P<0.05)。C-TIRADS与ACR-TIRADS的曲线下面积(AUC)面积分别为0.627和0.646，最佳诊断阈值分别为4b类、4类。C-TIRADS灵敏度、特异度、阳性预测值、阴性预测值分别是40.5%、81.7%、46.9%和77.6%。ACR-TIRADS灵敏度、特异度、阳性预测值、阴性预测值分别是64.9%、64.5%、42.1%和82.2%。结论：C-TIRADS与ACR-TIRADS 对风险分层管理FTC均有提示作用。ACR-TIRADS 灵敏度和阴性预测值较高，而C-TIRADS灵敏度低，但特异度高。甲状腺结节的最大径增大、低回声、边缘不规则/甲状腺外侵犯等超声特征要警惕是FTC的可能。

Objective: Comparison of two thyriod imaging reporting and data systems, C-TIRADS and ACR-TIRADS, of the Chinese Society of Ultrasound Medicine and the American College of Radiology, and to investigate the diagnostic value of both for follicular thyroid carcinoma(FTC), a malignant tumor originating from the follicular epithelium of the thyroid. Methods: Retrospective analysis of 37 nodules were pathologically confirmed as FTC by radical thyroidectomy and 93 nodules were from follicular adenomas(FA) originating from the follicular epithelium.The difference between FTC and FA groups was compared of the patient of gender, age and nodule location.The positive criterion of nodule maximum diameter ≥2.05 cm was used to compare the differences between the respective scoring rules of C-TIRADS and ACR-TIRADS in the FTC and FA groups, and the diagnostic efficacy of the two systems for FTC. Results: There was no statistically significant difference in the ultrasound characteristics of patients' gender, age, nodule location, solidity, irregular morphology, and strong echogenicity between the FTC and FA groups(P>0.05), whereas the differences in ultrasound characteristics of increased nodule maximum diameter, hypoecho, and irregular margins/extrathyroidal invasion were statistically significant(P<0.05).The area under curve(AUC) of C-TIRADS and ACR-TIRADS were 0.627 and 0.646, respectively.And the optimal diagnostic thresholds were category 4b and category 4, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of C-TIRADS were 81.7%, 40.5%, 46.9% and 77.6%, respectively. And the sensitivity, specificity, positive predictive value and negative predictive value of ACR-TIRADS were 64.9%, 64.5%, 42.1%, and 82.2%, respectively. Conclusion: Both C-TIRADS and ACR-TIRADS have implications for FTC risk hierarchical management. ACR-TIRADS had higher sensitivity and negative predictive value. C-TIRADS had lower sensitivity but higher specificity. The ultrasonic characteristics of thyroid nodules include of larger maximum diameter,hypoecho, irregular margins/extrathyroidal invasion should be alert to the possibility of FTC.

参考文献：

[1] 石福民,张宏伟,翟健,等.分化型甲状腺癌骨转移预测模型的构建[J].现代医学,2021,49(1):13-17.
[2] WU S J,TAN L,RUAN J L,et al.ACR TI-RADS classification combined with number of nodules,halo features optimizes diagnosis and prediction of follicular thyroid cancer[J].Clin Hemorheol Microcirc,2022,82(4):323-334.
[3] 中华医学会超声医学分会浅表器官和血管学组,中国甲状腺与乳腺超声人工智能联盟.2020甲状腺结节超声恶性危险分层中国指南:C-TIRADS[J].中华超声影像学杂志,2021,30(3):185-200.
[4] 赵璐璐,盛建国,刘怡,等.C-TIRADS与ACR-TIRADS对甲状腺结节诊断效能的分析[J].上海医学,2023,46(3):156-160.
[5] GHAI S,BRIEN C O,GOLDSTEIN D P,et al.Ultrasound in active surveillance for low-risk papillary thyroid cancer:imaging considerations in case selection and disease surveillance[J].Insights Imaging,2021,130(12):1-12.
[6] GUO Y X,LU L L.Ultrasound findings of the tall-cell variant of papillary thyroid carcinoma[J].Asian J Surg,2022,45(12):2884-2885.
[7] 伊丹丹,布尔兰,伊米努尔·伊力哈木,等.甲状腺乳头状癌临床病理亚型的研究进展[J].东南大学学报(医学版),2019,38(4):747-752.
[8] LI W,SONG Q,LAN Y,et al.The value of sonography in distinguishing follicular thyroid carcinoma from adenoma[J].Cancer Manag Res,2021,13:3991-4002.
[9] BOONROD A,AKKUS Z,CASTRO M R,et al.Thyroid nodule size as a predictor of malignancy in follicular and hurthle neoplasms[J].Asian Pac J Cancer Prev,2021,22(8):2597-2602.
[10] 周海燕,谭荣,黄静怡.甲状腺滤泡状癌与滤泡状腺瘤的高频超声鉴别诊断[J].医学影像学杂志,2018,28(7):1083-1086.
[11] 张伟文,张永明,钟毅,等.伴骨质破坏的颅-眶沟通性甲状腺滤泡状癌脑转移瘤1例及文献复习[J].立体定向和功能性神经外科杂志,2022,35(2):120-124.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录