Department of Radiology and Research Institute of Radiological Science, Yonsei University, College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 170-752, South Korea.
AJR Am J Roentgenol. 2010 Jan;194(1):31-7. doi: 10.2214/AJR.09.2822.
The purpose of this study was to compare the results with three sets of guidelines for fine-needle aspiration biopsy of thyroid nodules.
A total of 1,398 nodules confirmed with fine-needle aspiration biopsy or surgery were included in the study. We compared the diagnostic value of three sets of guidelines for ultrasound findings that should lead to fine-needle aspiration biopsy of a nodule. According to the Kim criteria, a nodule should have at least one of the following findings: marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, or length greater than width. According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has undergone substantial growth or is associated with abnormal cervical lymph nodes. According to the American Association of Clinical Endocrinologists, a hypoechoic nodule with at least one additional feature, such as irregular margins, length greater than width, and microcalcifications, should be biopsied.
For all nodules, the diagnostic accuracy of the Kim (area under the receiver operating characteristic curve [Az]=0.868) and American Association of Clinical Endocrinologists (Az=0.850) criteria was greater than that of the Society of Radiologists in Ultrasound criteria (Az=0.551). The number of nodules for which fine-needle aspiration biopsy was recommended (25.6%) was smallest with use of the American Association of Clinical Endocrinologists criteria, and the smallest number (7.3%) of missed malignant lesions was associated with use of the Kim criteria. The results did not change for the subgroup with nodules larger than 1 cm.
The Kim and American Association of Clinical Endocrinologists criteria are more accurate than the Society of Radiologists in Ultrasound criteria. The American Association of Clinical Endocrinologists guidelines are recommended for achieving high specificity, and the Kim criteria may be chosen for higher sensitivity.
本研究旨在比较三组甲状腺结节细针抽吸活检指南的结果。
共纳入 1398 个经细针抽吸活检或手术证实的结节。我们比较了三组指南对超声表现的诊断价值，这些超声表现应导致对结节进行细针抽吸活检。根据 Kim 标准，结节应至少具有以下一种表现：明显的低回声、不规则或微叶状边缘、微钙化或长度大于宽度。根据放射科医师协会的标准，应对直径 1 厘米或更大、有微钙化的结节，直径 1.5 厘米或更大、实性或有粗糙钙化的结节，以及直径 2 厘米或更大、有实性和囊性混合成分的结节进行活检，且结节有明显生长或与异常颈部淋巴结相关。根据美国临床内分泌医师协会的标准，应对具有至少一个其他特征（如不规则边缘、长度大于宽度、微钙化）的低回声结节进行活检。
对于所有结节，Kim（接受者操作特征曲线下面积 [Az] = 0.868）和美国临床内分泌医师协会（Az = 0.850）标准的诊断准确性均大于放射科医师协会（Az = 0.551）标准。建议进行细针抽吸活检的结节数量（25.6%）使用美国临床内分泌医师协会标准时最小，使用 Kim 标准时漏诊的恶性病变数量最小（7.3%）。对于直径大于 1 厘米的结节亚组，结果没有变化。
Kim 和美国临床内分泌医师协会标准比放射科医师协会标准更准确。为了达到高特异性，建议使用美国临床内分泌医师协会指南，为了更高的灵敏度，可能选择 Kim 标准。
