From the Department of Radiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710 (J.K.H., B.S.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., S.A.T.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (A.E.F.); Department of Radiology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.E.L.); Department of Radiology, Mayo Clinic College of Medicine, Rochester Minn (C.C.R.); Mecklenburg Radiology Associates, Charlotte, NC (N.A., D.S.); Rocky Mountain Radiologists, Denver, Colo (F.J.B.); Radiology Partners Research Institute, El Segundo, Calif (A.J.B.); Department of Radiology, Division of Ultrasound, Mayo Clinic, Phoenix, Ariz (N.D.); Memphis Radiological Professional Corporation, Methodist Le Bonheur Healthcare Memphis, Germantown, Tenn (J.R.H.); Duke Radiology of Raleigh, Duke University School of Medicine, Duke Raleigh Hospital, Raleigh, NC (R.C.V.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.).
Radiology. 2018 Apr;287(1):185-193. doi: 10.1148/radiol.2018172572. Epub 2018 Mar 2.
Purpose To compare the biopsy rate and diagnostic accuracy before and after applying the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) criteria for thyroid nodule evaluation. Materials and Methods In this retrospective study, eight radiologists with 3-32 years experience in thyroid ultrasonography (US) reviewed US features of 100 thyroid nodules that were cytologically proven, pathologically proven, or both in December 2016. The radiologists evaluated nodule features in five US categories and provided biopsy recommendations based on their own practice patterns without knowledge of ACR TI-RADS criteria. Another three expert radiologists served as the reference standard readers for the imaging findings. ACR TI-RADS criteria were retrospectively applied to the features assigned by the eight radiologists to produce biopsy recommendations. Comparison was made for biopsy rate, sensitivity, specificity, and accuracy. Results Fifteen of the 100 nodules (15%) were malignant. The mean number of nodules recommended for biopsy by the eight radiologists was 80 ± 16 (standard deviation) (range, 38-95 nodules) based on their own practice patterns and 57 ± 11 (range, 37-73 nodules) with retrospective application of ACR TI-RADS criteria. Without ACR TI-RADS criteria, readers had an overall sensitivity, specificity, and accuracy of 95% (95% confidence interval [CI]: 83%, 99%), 20% (95% CI: 16%, 25%), and 28% (95% CI: 21%, 37%), respectively. After applying ACR TI-RADS criteria, overall sensitivity, specificity, and accuracy were 92% (95% CI: 68%, 98%), 44% (95% CI: 33%, 56%), and 52% (95% CI: 40%, 63%), respectively. Although fewer malignancies were recommended for biopsy with ACR TI-RADS criteria, the majority met the criteria for follow-up US, with only three of 120 (2.5%) malignancy encounters requiring no follow-up or biopsy. Expert consensus recommended biopsy in 55 of 100 nodules with ACR TI-RADS criteria. Their sensitivity, specificity, and accuracy were 87% (95% CI: 48%, 98%), 51% (95% CI: 40%, 62%), and 56% (95% CI: 46%, 66%), respectively. Conclusion ACR TI-RADS criteria offer a meaningful reduction in the number of thyroid nodules recommended for biopsy and significantly improve the accuracy of recommendations for nodule management. RSNA, 2018 Online supplemental material is available for this article.
目的 比较应用美国放射学会（ACR）甲状腺影像报告和数据系统（TI-RADS）标准前后甲状腺结节评估的活检率和诊断准确性。
材料与方法 在这项回顾性研究中，8 名具有 3 至 32 年甲状腺超声（US）经验的放射科医生回顾了 2016 年 12 月经细胞学证实、病理证实或两者均证实的 100 个甲状腺结节的 US 特征。放射科医生在 5 个 US 类别中评估结节特征，并根据自己的实践模式提供活检建议，而不了解 ACR TI-RADS 标准。另外 3 名专家放射科医生作为影像发现的参考标准读者。回顾性地将 ACR TI-RADS 标准应用于 8 名放射科医生分配的特征，以产生活检建议。比较活检率、敏感性、特异性和准确性。
结果 100 个结节中有 15 个（15%）为恶性。根据自己的实践模式，8 名放射科医生推荐活检的平均结节数为 80±16（标准差）（范围，38-95 个结节），应用 ACR TI-RADS 标准后为 57±11（范围，37-73 个结节）。不应用 ACR TI-RADS 标准时，读者的总体敏感性、特异性和准确性分别为 95%（95%置信区间[CI]：83%，99%）、20%（95%CI：16%，25%）和 28%（95%CI：21%，37%）。应用 ACR TI-RADS 标准后，总体敏感性、特异性和准确性分别为 92%（95%CI：68%，98%）、44%（95%CI：33%，56%）和 52%（95%CI：40%，63%）。虽然应用 ACR TI-RADS 标准后活检推荐的恶性肿瘤较少，但大多数符合随访 US 的标准，仅 120 个恶性肿瘤中有 3 个（2.5%）无需随访或活检。ACR TI-RADS 标准专家共识建议活检 55 个有 ACR TI-RADS 标准的结节。他们的敏感性、特异性和准确性分别为 87%（95%CI：48%，98%）、51%（95%CI：40%，62%）和 56%（95%CI：46%，66%）。
结论 ACR TI-RADS 标准显著减少了推荐活检的甲状腺结节数量，并显著提高了结节管理建议的准确性。
RSNA，2018 在线补充材料可在本文中获得。
