Macedo Bruno Mussoi de, Izquierdo Rogério F, Golbert Lenara, Meyer Erika L Souza
Thyroid Section, Endocrine Division, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
Arch Endocrinol Metab. 2018 Apr 5;62(2):131-138. doi: 10.20945/2359-3997000000018. Print 2018 Mar-Apr.
Ultrasonography (US) is the best diagnostic tool for initial assessment of thyroid nodule. Recently, data reporting systems for thyroid lesions, such as the Thyroid Imaging Reporting and Data System (TI-RADS) and American Thyroid Association (ATA), which stratifies the risk for malignancy, have demonstrated good performance in differentiating malignant thyroid nodules. The purpose of this study is to determine the reliability of both data reporting systems in predicting thyroid malignancy in a tertiary care hospital.
We evaluated 195 thyroid nodules using modified TI-RADS and ATA risk stratification. The results were compared to the cyto-pathology analysis. Histopathological results were available for 45 cases after surgery, which is considered the golden standard for diagnosis of thyroid cancer.
When compared with cytological results, sensitivity, specificity, negative predictive value (NPV), and accuracy were 100, 61.1, 100, and 63%, respectively, for TI-RADS; and 100, 75, 100, and 76%, respectively, for ATA. When compared with histopathological results, sensitivity, specificity, NPV, and accuracy were 90, 51.4, 94.7, and 60% respectively, for TI-RADS; and 100, 60, 100, and 68%, respectively, for ATA. All patients with malignant nodules were classified in the categories 4 or 5 of TI-RADS and in the intermediate or high suspicion risk according to the ATA system.
Both TI-RADS and the ATA guidelines have high sensitivity and NPV for the diagnosis of thyroid carcinoma. These systems are feasible for clinical application, allowing to better select patients to undergo fine-needle aspiration biopsies.
超声检查（US）是甲状腺结节初始评估的最佳诊断工具。最近，甲状腺病变数据报告系统，如甲状腺影像报告和数据系统（TI-RADS）以及美国甲状腺协会（ATA）对恶性风险进行分层，在鉴别甲状腺恶性结节方面表现出良好性能。本研究的目的是确定这两种数据报告系统在三级医院预测甲状腺恶性病变中的可靠性。
我们使用改良的TI-RADS和ATA风险分层对195个甲状腺结节进行评估。将结果与细胞病理学分析进行比较。术后45例患者有组织病理学结果，这被视为甲状腺癌诊断的金标准。
与细胞学结果相比，TI-RADS的敏感性、特异性、阴性预测值（NPV）和准确性分别为100%、61.1%、100%和63%；ATA的分别为100%、75%、100%和76%。与组织病理学结果相比，TI-RADS的敏感性、特异性、NPV和准确性分别为90%、51.4%、94.7%和60%；ATA的分别为100%、60%、100%和68%。所有恶性结节患者在TI-RADS中被分类为4类或5类，在ATA系统中被分类为中度或高度可疑风险。
TI-RADS和ATA指南在甲状腺癌诊断中均具有高敏感性和NPV。这些系统在临床应用中可行，有助于更好地选择患者进行细针穿刺活检。
