Ng Soh-Ching, Kuo Sheng-Fong, Hua Chung-Ching, Huang Bie-Yu, Chiang Kun-Chun, Chu Yin-Yi, Hsueh Chuen, Lin Jen-Der
Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan.
Departments of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan.
J Ultrasound Med. 2018 Mar;37(3):667-674. doi: 10.1002/jum.14377. Epub 2017 Sep 7.
It is difficult to establish a diagnosis of the follicular variant of papillary thyroid carcinoma (PTC) using fine-needle aspiration cytology (FNAC). Preoperative features on ultrasound (US) imaging are different between follicular PTC and classic PTC. This study developed a risk score system to differentiate follicular PTC from classic PTC and to correlate the risk score of follicular PTC with its FNAC categories and pathologic features.
The US features, FNAC results, and pathologic reports of 156 follicular PTC nodules and 152 classic PTC nodules from 296 patients with PTC along with their clinical characteristics were reviewed retrospectively. A risk score system based on US features was developed by multivariate logistic regression to differentiate classic PTC from follicular PTC nodules. The risk scores were then correlated with the FNAC category and pathologic features of the nodules.
The US risk score (5 × echogenicity + 3 × calcifications + 3 × marginal regularity) had an area under the receiver operating characteristic curve of 0.85 and a cutoff value of 8.0, with specificity of 87% and sensitivity of 69% for predicting a classic PTC nodule. The follicular PTC nodules with low Bethesda categorization (I-III) had a median US risk score of 6 (range, 0-11), which was higher than that of nodules with high categorization (IV-VI; median, 3; range, 0-11).
The US risk score may be useful in differentiating classic PTC from follicular PTC and complementary to FNAC in identifying follicular PTC.
使用细针穿刺细胞学检查（FNAC）来诊断甲状腺乳头状癌（PTC）的滤泡变体很困难。滤泡性PTC和经典PTC在超声（US）成像上的术前特征有所不同。本研究开发了一种风险评分系统，以区分滤泡性PTC和经典PTC，并将滤泡性PTC的风险评分与其FNAC分类和病理特征相关联。
回顾性分析了296例PTC患者的156个滤泡性PTC结节和152个经典PTC结节的US特征、FNAC结果、病理报告及其临床特征。通过多因素逻辑回归建立了基于US特征的风险评分系统，以区分经典PTC和滤泡性PTC结节。然后将风险评分与结节的FNAC分类和病理特征相关联。
US风险评分（5×回声性 + 3×钙化 + 3×边缘规则性）在受试者工作特征曲线下的面积为0.85，截断值为8.0，预测经典PTC结节的特异性为87%，敏感性为69%。低贝塞斯达分类（I-III）的滤泡性PTC结节的US风险评分中位数为6（范围0-11），高于高分类（IV-VI）结节的评分（中位数3；范围0-11）。
US风险评分可能有助于区分经典PTC和滤泡性PTC，并且在识别滤泡性PTC方面可作为FNAC的补充。
