Department of Radiology, Seoul National University Bundang Hospital, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Endocrine. 2018 Aug;61(2):285-292. doi: 10.1007/s12020-018-1594-4. Epub 2018 Apr 21.
To evaluate the applicability of ultrasound (US)-based Thyroid Imaging Reporting and Data System (TI-RADS) for evaluating medullary thyroid carcinoma (MTC).
US images and medical records of patients with cytopathology-confirmed MTC between June 2003 and November 2016 were retrospectively reviewed. Four independent reviewers (two experienced and two inexperienced radiologists) evaluated 57 pre-operative US images of patients with MTC for shape, composition, echogenicity, margin, calcification of the MTC nodules, and categorized the nodules using TI-RADS classification. Weighted Kappa statistics was used to determine the inter-observer agreement of TI-RADS. Univariate and multivariate analyses were performed to assess US findings associated with lymph node metastasis.
Ninety-five percent of nodules were classified as either high suspicion (68%) or intermediate suspicion (26%). The overall inter-rater agreement was good (Kappa 0.84, agreement 91.52%), and inexperienced reviewers also showed good agreements with the most experienced reviewer (weighted Kappa 0.73 and 0.81). According to the univariate analysis, TI-RADS category 5, shape, microcalcification, and extrathyroid extension were significantly associated with lymph node metastasis in MTC patients (p = 0.003, 0.008, 0.001, and 0.021, respectively). As per the multivariate analysis, the presence of microcalcification and the irregular shape of the nodule were significantly associated with metastatic lymph nodes in MTC patients (odds ratio, 26.6; 95% CI, 2.7-263.7, p = 0.005, odds ratio, 14.7; 95% CI, 1.3-170, p = 0.031, respectively).
TI-RADS is applicable for the evaluation of MTC nodules with good inter-observer agreement.
评估基于超声（US）的甲状腺影像报告和数据系统（TI-RADS）在评估甲状腺髓样癌（MTC）中的适用性。
回顾性分析 2003 年 6 月至 2016 年 11 月期间经细胞学证实的 MTC 患者的 US 图像和病历资料。四位独立的观察者（两位有经验的和两位无经验的放射科医生）评估了 57 例 MTC 患者的术前 US 图像，评估内容包括结节的形状、成分、回声、边缘、钙化情况，并采用 TI-RADS 分类对结节进行分类。采用加权 Kappa 统计量评估 TI-RADS 的观察者间一致性。采用单变量和多变量分析评估与淋巴结转移相关的 US 表现。
95%的结节被归类为高度可疑（68%）或中度可疑（26%）。总体观察者间一致性较好（Kappa 0.84，一致性 91.52%），无经验的观察者与最有经验的观察者之间也有较好的一致性（加权 Kappa 0.73 和 0.81）。根据单变量分析，TI-RADS 类别 5、形状、微钙化和甲状腺外延伸与 MTC 患者的淋巴结转移显著相关（p=0.003、0.008、0.001 和 0.021）。根据多变量分析，微钙化的存在和结节的不规则形状与 MTC 患者的转移性淋巴结显著相关（比值比，26.6；95%可信区间，2.7-263.7，p=0.005；比值比，14.7；95%可信区间，1.3-170，p=0.031）。
TI-RADS 适用于评估 MTC 结节，观察者间一致性较好。
