From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostatistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea.
Radiology. 2016 Mar;278(3):917-24. doi: 10.1148/radiol.2015150056. Epub 2015 Sep 8.
To compare malignancy risk stratification of thyroid nodules with the 2014 American Thyroid Association (ATA) management guidelines and the Thyroid Imaging Reporting and Data System (TIRADS).
This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. From November 2013 to July 2014, 1293 thyroid nodules in 1241 patients (mean age, 50.8 years ± 13.5) were included in this study. All nodules measured at least 10 mm. Solidity, hypoechogenicity or marked hypoechogenicity, microlobulated to irregular margin, microcalcifications or mixed calcifications, and nonparallel shape were considered suspicious features at ultrasonography (US). A TIRADS category and the US pattern as determined with ATA guidelines were assigned to each nodule. The correlation between the TIRADS category or ATA pattern and the malignancy rate was evaluated with the Spearman rank test.
Of the 1293 thyroid nodules, 1059 (81.9%) were benign and 234 (18.1%) were malignant. Forty-four of the 1293 nodules (3.4%) did not meet the criteria for the ATA patterns and were classified as "not specified." The malignancy rates of TIRADS category 3, 4a, 4b, 4c, and 5 nodules were 1.9% (six of 316 nodules), 4.2% (17 of 408 nodules), 12.9% (33 of 256 nodules), 49.8% (130 of 261 nodules), and 92.3% (48 of 52 nodules), respectively, with significant differences between categories (P < .001). Malignancy rates of nodules with very low, low, intermediate, and high suspicion for malignancy with the ATA guidelines and not specified patterns were 2.7% (11 of 407 nodules), 3.1% (10 of 323 nodules), 16.7% (39 of 233 nodules), 58.0% (166 of 286 nodules), and 18.2% (eight of 44 nodules), respectively, with significant differences between patterns (P < .001). There was high correlation between classification with TIRADS (r = 1.000, P < .001) and ATA guidelines (r = 0.900, P = 0.037), without statistically significant differences (P = .873).
Both TIRADS and the ATA guidelines provide effective malignancy risk stratification for thyroid nodules. Nodules that do not meet the criteria for a specific pattern with the ATA guidelines have a relatively high risk of malignancy (18.2%).
比较甲状腺结节的恶性风险分层与 2014 年美国甲状腺协会（ATA）管理指南和甲状腺影像报告和数据系统（TIRADS）。
本回顾性研究经机构审查委员会批准。豁免了获得知情同意的要求。从 2013 年 11 月至 2014 年 7 月，纳入了 1241 例患者的 1293 个甲状腺结节（平均年龄 50.8 岁±13.5）。所有结节均至少为 10mm。在超声（US）中，实性、低回声或明显低回声、微分叶状或不规则边缘、微钙化或混合钙化以及非平行形状被认为是可疑特征。每个结节均被分配 TIRADS 类别和 ATA 指南确定的 US 模式。使用 Spearman 秩检验评估 TIRADS 类别或 ATA 模式与恶性率之间的相关性。
在 1293 个甲状腺结节中，1059 个（81.9%）为良性，234 个（18.1%）为恶性。1293 个结节中有 44 个（3.4%）不符合 ATA 模式标准，被归类为“未指定”。TIRADS 类别 3、4a、4b、4c 和 5 结节的恶性率分别为 1.9%（316 个结节中的 6 个）、4.2%（408 个结节中的 17 个）、12.9%（256 个结节中的 33 个）、49.8%（261 个结节中的 130 个）和 92.3%（52 个结节中的 48 个），类别之间存在显著差异（P<0.001）。ATA 指南和未指定模式下恶性风险低、低、中、高度可疑的结节恶性率分别为 2.7%（407 个结节中的 11 个）、3.1%（323 个结节中的 10 个）、16.7%（233 个结节中的 39 个）、58.0%（286 个结节中的 166 个）和 18.2%（44 个结节中的 8 个），模式之间存在显著差异（P<0.001）。TIRADS 分类（r=1.000，P<0.001）和 ATA 指南（r=0.900，P=0.037）之间高度相关，无统计学差异（P=0.873）。
TIRADS 和 ATA 指南均能有效对甲状腺结节的恶性风险进行分层。不符合 ATA 指南特定模式标准的结节恶性风险相对较高（18.2%）。
