From the Departments of Radiology (E.J.H.) and Biostatistics (S.Y.K.), Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 443-380, Korea; Department of Radiology, GangNeung Asan Hospital, Gangneung-si, Gangwon-do, Korea (D.G.N.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (D.G.N.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea (J.Y.S.); and Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (J.H.K.).
Radiology. 2018 Jun;287(3):893-900. doi: 10.1148/radiol.2018171074. Epub 2018 Feb 21.
Purpose To compare the diagnostic performance of ultrasonography (US)-based fine-needle aspiration biopsy (FNAB) criteria from seven international societies in the detection of thyroid malignancy. Materials and Methods This study included a total of 2000 consecutive thyroid nodules (≥1 cm) in 1802 patients with final diagnoses from January 2010 to May 2011. US features of the thyroid nodules were retrospectively reviewed and were classified according to the categories defined by the seven international society guidelines. The diagnostic performance of US-based FNAB criteria in the detection of thyroid malignancy and unnecessary FNAB rates were calculated and compared by using a generalized estimating equation method. Results Of the 2000 thyroid nodules, 1546 (78.3%) were benign and 454 (22.7%) were malignant, with papillary carcinoma comprising 85.5% of all malignancies. The Korean Thyroid Association/Korean Society of Thyroid Radiology (KTA/KSThR) (94.5%), National Comprehensive Cancer Network (NCCN) (92.5%), and American Thyroid Association (ATA) (89.6%) guidelines were more sensitive than those of the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.4%), American College of Radiology (ACR) (74.7%), French Society of Endocrinology (FSE) (72.7%), and Society of Radiology in Ultrasound (SRU) (70.9%) (P < .001), while the latter guidelines had higher specificity (P < .001). The rate of unnecessary FNAB was lowest with the ACR guidelines (25.3%), followed by the FSE (29.1%), AACE/ACE/AME (32.5%), SRU (45.2%), ATA (51.7%), NCCN (54.0%), and KTA/KSThR (56.9%) guidelines. Conclusion Because the diagnostic performance of US-based FNAB criteria varies according to the individual international society guidelines, clinicians should be aware of the strengths and weaknesses of US-based FNAB criteria in the management of thyroid nodules. RSNA, 2018 Online supplemental material is available for this article.
目的 比较 7 个国际学会的超声引导细针抽吸活检（FNAB）标准在甲状腺良恶性诊断中的表现。
材料与方法 本研究纳入了 2010 年 1 月至 2011 年 5 月期间 1802 例患者的 2000 个直径≥1cm 的甲状腺结节，最终诊断结果。回顾性分析甲状腺结节的超声特征，并根据 7 个国际学会指南的分类进行分类。采用广义估计方程方法计算并比较了基于超声的 FNAB 标准在检测甲状腺恶性肿瘤和不必要 FNAB 率方面的诊断性能。
结果 2000 个甲状腺结节中，1546 个（78.3%）为良性，454 个（22.7%）为恶性，其中乳头状癌占所有恶性肿瘤的 85.5%。韩国甲状腺协会/韩国甲状腺放射学会（KTA/KSThR）（94.5%）、美国国家综合癌症网络（NCCN）（92.5%）和美国甲状腺协会（ATA）（89.6%）指南比美国临床内分泌医师协会/美国内分泌学会/内分泌医师协会（AACE/ACE/AME）（80.4%）、美国放射学会（ACR）（74.7%）、法国内分泌学会（FSE）（72.7%）和超声放射学会（SRU）（70.9%）更敏感（P<.001），而后者的特异性更高（P<.001）。不必要 FNAB 的比例最低的是 ACR 指南（25.3%），其次是 FSE（29.1%）、AACE/ACE/AME（32.5%）、SRU（45.2%）、ATA（51.7%）、NCCN（54.0%）和 KTA/KSThR（56.9%）指南。
结论 由于基于超声的 FNAB 标准的诊断性能因各国际学会指南而异，因此临床医生应了解基于超声的 FNAB 标准在甲状腺结节管理中的优缺点。
RSNA，2018 在线补充材料可在本文中获取。
