ACR TI-RADS 与 ATA US 评分有助于对具有不确定细胞学特征的甲状腺结节进行管理。
ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology.
机构信息
Department of Endocrinology and Metabology, Federal University of Paraná- Brazil, Av. Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, 80.030-110, Brazil.
Department of Endocrinology, Clinical Hospital of the Federal University, Av. Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, 80.030-110, Brazil.
出版信息
BMC Endocr Disord. 2019 Oct 29;19(1):112. doi: 10.1186/s12902-019-0429-5.
BACKGROUND
Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management.
METHODS
The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination.
RESULTS
Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively).
CONCLUSIONS
Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.
背景
目前，细胞学不确定的甲状腺结节对临床决策构成了挑战。我们的主要目的是确定美国放射学院（ACR）TI-RADS 和 2015 年美国甲状腺协会（ATA）指南的分类是否可以与甲状腺细胞学报告的 Bethesda 系统（TBSRTC）联合使用，以对不确定的甲状腺结节的恶性风险进行分层，并指导其临床管理。
方法
本回顾性研究纳入了 2012 年 1 月至 2016 年 6 月间因细胞学不确定（44 例 Bethesda III、52 例 Bethesda IV 和 44 例 Bethesda V）而接受超声引导下细针抽吸细胞学检查（FNAC）的 139 例患者的 140 个甲状腺结节。这些患者的术前甲状腺超声图像和术后组织学结果均可用。一位盲于细胞学和组织学诊断的放射科医生根据 ACR TIRADS 评分和 2015 年 ATA 指南推荐的超声模式对每个纳入的结节进行分类。根据 Bethesda、TI-RADS 评分、ATA US 模式及其组合，评估恶性肿瘤风险。
结果
在检查的 140 个不确定的甲状腺结节中，74 个（52.9%）组织学上为良性。在 Bethesda III、IV 和 V 之间观察到不同的恶性率（p<0.001）。在两种超声分类（TI-RADS 和 ATA）中，根据 US 可疑程度（p<0.001），恶性率均有所增加。甲状腺结节分类为 Bethesda III 和最低风险的 US 类别（ATA 为极低、低和中度可疑，TI-RADS 为 2、3 和 4a）在两种分类中均具有 95.3%的敏感性和 94.3%和 94.1%的阴性预测值。最高风险的 US 类别（ATA 为高度可疑，TI-RADS 为 4b、4c 和 5）与癌症显著相关（比值比[ORs]分别为 14.7 和 9.8）。
结论
超声分类、ACR TI-RADS 和 ATA 指南可能有助于指导不确定甲状腺结节的管理，建议对低风险 US 可疑性和 Bethesda III 的结节采取保守方法，而对高风险 US 可疑性和 Bethesda IV 或 V 的结节应考虑进行分子检测和手术。
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