Martinez-Rios Claudia, Daneman Alan, Bajno Lydia, van der Kaay Danielle C M, Moineddin Rahim, Wasserman Jonathan D
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Pediatr Radiol. 2018 Jan;48(1):74-84. doi: 10.1007/s00247-017-3974-y. Epub 2017 Oct 5.
Individual ultrasound (US) features have limited ability to distinguish benign from malignant thyroid nodules. Adult-based systems have been developed to integrate the sonographic features in an effort to improve diagnostic accuracy. None, however, has been validated in children, in whom the likelihood of malignancy is 2-5 times higher than adults.
To assess the performance of two adult-based sonographic (US) stratification methods for assessment of thyroid nodules in children.
This retrospective study comprised 124 children who underwent thyroid US. Three radiologists reviewed the US data using the American Thyroid Association (ATA) and the Thyroid Image Reporting and Data System (TI-RADS). Radiologists' accuracy and agreement was assessed. The reference standard was histopathology/cytology or 2-year follow-up of clinical outcome for nonoperative cases.
We assessed 71 benign and 52 malignant nodules and excluded 1 nodule. Using the ATA pattern descriptions, 80% of malignant nodules were classified as "high" 36/52 (69%) or "intermediate" 6/52 (11%) likelihood of malignancy. A total of 20/71 (28%) benign nodules were also classified within these two categories. Using the TI-RADS, malignant nodules were classified as 2, 3, 4a, 4b, 4c and 5, with rate of malignancy of 0%, 0%, 7/52 (13.5%), 7/52 (13.5%), 32/52 (61.5%) and 6/52 (11.5%), respectively. Benign nodules were also classified in the 4a (26/71; 36.6%), 4b (17/71; 24%), 4c (14/71; 19.7%) and 5 (1/71; 1.4%) categories. The positive and negative predictive values were 68.0% and 87.5% for ATA, and 71.7% and 80.0% for TI-RADS.
We validated the use of ATA and TI-RADS methods in children and showed that they have test characteristics similar to those in adults, although neither is independently sufficient to discriminate nodules' likelihood of malignancy.
甲状腺结节的个体超声（US）特征在区分良性与恶性方面能力有限。基于成人的系统已被开发出来，用于整合超声特征以提高诊断准确性。然而，尚无系统在儿童中得到验证，而儿童甲状腺结节的恶性可能性比成人高2至5倍。
评估两种基于成人的超声（US）分层方法在评估儿童甲状腺结节中的性能。
这项回顾性研究纳入了124例接受甲状腺超声检查的儿童。三位放射科医生使用美国甲状腺协会（ATA）和甲状腺影像报告和数据系统（TI-RADS）对超声数据进行了评估。评估了放射科医生的准确性和一致性。参考标准为组织病理学/细胞学检查或非手术病例的2年临床结局随访。
我们评估了71个良性结节和52个恶性结节，并排除了1个结节。使用ATA模式描述，80%的恶性结节被分类为恶性可能性“高”36/52（69%）或“中等”6/52（11%）。共有20/71（28%）的良性结节也被分类在这两个类别中。使用TI-RADS，恶性结节被分类为2、3、4a、4b、4c和5类，恶性率分别为0%、0%、7/52（13.5%）、7/52（13.5%）、32/52（61.5%）和6/52（11.5%）。良性结节也被分类在4a（26/71；36.6%）、4b（17/71；24%）、4c（14/71；19.7%）和5（1/71；1.4%）类别中。ATA的阳性和阴性预测值分别为68.0%和87.5%，TI-RADS的阳性和阴性预测值分别为71.7%和80.0%。
我们验证了ATA和TI-RADS方法在儿童中的应用，并表明它们具有与成人相似的检测特征，尽管两者都不足以独立区分结节的恶性可能性。
