1 Department of Radiology, Ajou University School of Medicine , Suwon, Korea.
2 Department of Radiology, Human Medical Imaging and Intervention Center , Seoul, Korea.
Thyroid. 2018 Nov;28(11):1532-1537. doi: 10.1089/thy.2018.0094.
The aim of this study was to compare the diagnostic performance of ultrasound (US)-based risk-stratification systems for thyroid nodules in the 2015 American Thyroid Association (ATA) guidelines with those of the 2016 Korean Thyroid Association (KTA)/Korean Society of Thyroid Radiology (KSThR) and 2017 American College of Radiology (ACR) guidelines.
From June 2013 to May 2015, a total of 902 consecutive thyroid nodules were enrolled in four institutions, and their US features were retrospectively reviewed and classified using the categories defined by the three guidelines. The malignancy risk of each category, as defined by all three risk-stratification systems, was calculated, and the diagnostic performance of the fine-needle aspiration (FNA) indications of the ATA guidelines were compared to those of the KTA/KSThR and ACR guidelines.
Of all nodules, 636 (70.5%) were benign and 266 (29.5%) malignant. The calculated malignancy risks for ATA categories 5, 4, 3, 2, and 1 nodule(s) were 71.7, 21.5, 2.6, 3.8, and 0%. Of all nodules, 7.6% (69/902) did not meet the ATA pattern criteria, but the malignancy risk was calculated to be 10.1% (7/69). The ATA guidelines afforded significantly higher diagnostic sensitivity (95.0%) than the ACR guidelines (80.2%; p = 0.001) but a lower specificity (38.1 vs. 68.9%; p < 0.001). On the other hand, the ATA guidelines exhibited a lower diagnostic sensitivity than the KTA/KSThR guidelines (100.0%; p = 0.07) but a higher specificity (28.2%; p < 0.001). The unnecessary FNA rate was the lowest when the ACR guidelines were used (25.8%), followed by the ATA (51.2%) and KTA/KSThR (59.4%) guidelines.
The 2015 ATA guidelines afford relatively moderate sensitivity and an unnecessary FNA rate for thyroid cancer detection compared to the 2016 KTA/KSThR and 2017 ACR guidelines. US practitioners require a deep understanding of the benefits and risks of the US-based FNA criteria of different guidelines and potential impact on the diagnosis of low-risk thyroid cancers.
本研究旨在比较 2015 年美国甲状腺协会（ATA）指南、2016 年韩国甲状腺协会（KTA）/韩国甲状腺放射学会（KSThR）和 2017 年美国放射学会（ACR）指南中基于超声（US）的甲状腺结节危险分层系统的诊断性能。
本研究回顾性分析了 2013 年 6 月至 2015 年 5 月期间来自四家机构的 902 例连续甲状腺结节患者的 US 特征，并使用三个指南中定义的类别进行分类。根据所有三个风险分层系统，计算每个类别的恶性风险，并比较 ATA 指南的细针抽吸（FNA）适应证的诊断性能与 KTA/KSThR 和 ACR 指南。
在所有结节中，636 个（70.5%）为良性，266 个（29.5%）为恶性。ATA 类别 5、4、3、2 和 1 个结节的恶性风险分别为 71.7%、21.5%、2.6%、3.8%和 0%。所有结节中，7.6%（69/902）不符合 ATA 模式标准，但计算出的恶性风险为 10.1%（7/69）。ATA 指南的诊断敏感性显著高于 ACR 指南（95.0% vs. 80.2%；p=0.001），但特异性较低（38.1% vs. 68.9%；p<0.001）。另一方面，ATA 指南的诊断敏感性低于 KTA/KSThR 指南（100.0%；p=0.07），但特异性较高（28.2%；p<0.001）。使用 ACR 指南时，不必要的 FNA 率最低（25.8%），其次是 ATA 指南（51.2%）和 KTA/KSThR 指南（59.4%）。
与 2016 年 KTA/KSThR 和 2017 年 ACR 指南相比，2015 年 ATA 指南在检测甲状腺癌方面提供了相对中等的敏感性和不必要的 FNA 率。US 医师需要深入了解不同指南的基于 US 的 FNA 标准的优缺点及其对低危甲状腺癌诊断的潜在影响。
