Delfim Ricardo Luiz Costantin, Veiga Leticia Carrasco Garcez da, Vidal Ana Paula Aguiar, Lopes Flávia Paiva Proença Lobo, Vaisman Mário, Teixeira Patrícia de Fatima Dos Santos
Departamento de Endocrinologia, Universidade Federal do Rio de Janeiro (UFRJ). Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brasil.
Departamento de Endocrinologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil.
Arch Endocrinol Metab. 2017 May-Jun;61(3):211-221. doi: 10.1590/2359-3997000000262. Epub 2017 Mar 27.
The aim of this study was to describe the ultrasound features of benign and malignant thyroid nodules and evaluate the likelihood of malignancy associated with each feature according to the Bethesda System for Reporting Thyroid Cytopathology and histopathology. With this analysis, we propose a new TI-RADS classification system.
The likelihood of malignancy from ultrasound features were assessed in 1413 thyroid nodules according to the Bethesda System for Reporting Thyroid Cytopathology and histopathological findings. A score was established by attributing different weights to each ultrasound feature evaluated.
Features positively associated with malignancy in bivariate analysis received a score weight of +1. We attributed a weight of +2 to features which were independently associated with malignancy in a multivariate analysis and +3 for those associated with the highest odds ratio for malignancy (> 10.0). Hence, hypoechogenicity (graded as mild, moderate or marked, according to a comparison with the overlying strap muscle), microcalcification and irregular/microlobulated margin received the highest weights in our scoring system. Features that were negatively associated with malignancy received weights of -2 or -1. In the proposed system a cutoff score of 2 (sensitivity 97.4% and specificity 51.6%) was adopted as a transition between probably benign (TI-RADS 3) and TI-RADS 4a nodules. Overall, the frequency of malignancy in thyroid nodules according to the categories was 1.0% for TI-RADS 3, 7.8% for TI-RADS 4a, 35.3% for TI-RADS 4b, and 84.7% for TI-RADS 5.
A newly proposed TI-RADS classification adequately assessed the likelihood of malignancy in thyroid nodules.
本研究旨在描述良性和恶性甲状腺结节的超声特征，并根据甲状腺细胞病理学报告的贝塞斯达系统和组织病理学评估与每个特征相关的恶性可能性。通过该分析，我们提出了一种新的甲状腺影像报告和数据系统（TI-RADS）分类系统。
根据甲状腺细胞病理学报告的贝塞斯达系统和组织病理学结果，对1413个甲状腺结节的超声特征的恶性可能性进行评估。通过对每个评估的超声特征赋予不同权重来建立一个评分。
在双变量分析中与恶性呈正相关的特征获得+1的评分权重。在多变量分析中与恶性独立相关的特征赋予+2的权重，与恶性最高比值比（>10.0）相关的特征赋予+3的权重。因此，低回声（根据与上方带状肌的比较分为轻度、中度或重度）、微钙化和不规则/微小分叶状边缘在我们的评分系统中获得最高权重。与恶性呈负相关的特征赋予-2或-1的权重。在提出的系统中，采用2分的临界值（敏感性97.4%，特异性51.6%）作为可能良性（TI-RADS 3）和TI-RADS 4a结节之间的过渡。总体而言，根据类别，TI-RADS 3甲状腺结节的恶性频率为1.0%，TI-RADS 4a为7.8%，TI-RADS 4b为35.3%，TI-RADS 5为84.7%。
新提出的TI-RADS分类充分评估了甲状腺结节的恶性可能性。
