Periakaruppan Gokulakrishnan, Seshadri Krishna G, Vignesh Krishna G M, Mandava Rupesh, Sai Venkata P M, Rajendiran S
Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):651-655. doi: 10.4103/ijem.IJEM_27_18.
In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology.
This prospective study includes 184 patients studied over a period of 2 years (April 2015-April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests.
Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies.
The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.
近年来，高分辨率超声甲状腺成像为甲状腺结节的临床诊疗带来了重大变革。甲状腺成像中有多种风险分层系统，其目的不仅是减少观察者间的差异，还在于建立有效的沟通体系。甲状腺影像报告和数据系统（TIRADS）分类系统与乳腺病变的乳腺影像报告和数据系统类似，是其中最有用的。据我们所知，在这方面基于印度人群发表的研究文章寥寥无几。在本文中，我们对印度人群的甲状腺结节进行了高分辨率超声研究，并尝试将TIRADS与甲状腺细胞病理学报告的贝塞斯达系统进行关联。
这项前瞻性研究纳入了184例患者，研究历时2年（2015年4月至2017年4月）。这些患者在B超检查中有甲状腺结节，并计划进行细针穿刺细胞学检查（FNAC）。在随访期间同时将这些结节的贝塞斯达分类制成表格。通过比较这些数据，最终使用准确性、阳性预测值（PPV）、交叉表和卡方检验来评估TIRADS在区分良性与恶性结节方面的有效性。
在117个TIRADS 2类结节中，没有一个最终属于贝塞斯达IV类或更高类别，这意味着这些结节均非恶性。TIRADS 2、TIRADS 3、TIRADS 4和TIRADS 5类结节的恶性风险分别为0%、2.2%、38.5%和77.8%。我们研究中的恶性风险百分比与其他重要研究得出的值相似。
基于超声的TIRADS系统能够在一定置信水平下有效地推断出特定结节为恶性的概率。综合我们的研究结果和其他文献综述，可以安全地假设，对于大多数新检测出的TIRADS 2类结节患者，至少可以推迟进行FNAC检查。根据我们的经验，TIRADS超声分类与贝塞斯达细胞学之间存在显著相关性，尤其是对于良性结节。
