Department of Surgery, Columbia University Medical Center, New York, New York, USA.
Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
Oncologist. 2020 May;25(5):398-403. doi: 10.1634/theoncologist.2019-0362. Epub 2019 Nov 19.
Ultrasound plays a critical role in evaluating thyroid nodules. We compared the performance of the two most popular ultrasound malignancy risk stratification systems, the 2015 American Thyroid Association (ATA) guidelines and the American College of Radiology Thyroid Imaging and Reporting Data System (ACR TI-RADS).
We retrospectively identified 250 thyroid nodules that were surgically removed from 137 patients. Their ultrasound images were independently rated using both ATA and ACR TI-RADS by six raters with expertise in ultrasound interpretation. For each system, we generated a receiver operating characteristic curve and calculated the area under the curve (AUC).
Sixty-five (26%) nodules were malignant. There was "fair agreement" among raters for both ATA and ACR TI-RADS. Our observed malignancy risks for ATA and ACR TI-RADS categories were similar to expected risk thresholds with a few notable exceptions including the intermediate ATA risk category and the three highest risk categories for ACR TI-RADS. Biopsy of 226 of the 250 nodules would be indicated by ATA guidelines based on nodule size and mean ATA rating. One hundred forty-six nodules would be biopsied based on ACR TI-RADS. The sensitivity, specificity, and negative and positive predictive values were 92%, 10%, 79%, and 27%, respectively, for ATA and 74%, 47%, 84%, and 33%, respectively, for ACR TI-RADS. The AUC for ATA was 0.734 and for ACR TI-RADS was 0.718.
Although both systems demonstrated good diagnostic performance, ATA guidelines resulted in a greater number of thyroid biopsies and exhibited more consistent malignancy risk prediction for higher risk categories.
With the rising incidence of thyroid nodules, the need for accurate detection of malignancy is important to avoid the overtreatment of benign nodules. Ultrasonography is one of the key tools for the evaluation of thyroid nodules, although the use of many different ultrasound risk stratification systems is a hindrance to clinical collaboration in everyday practice and the comparison of data in research. The first step toward the development of a universal thyroid nodule ultrasound malignancy risk stratification system is to better understand the strengths and weaknesses of the current systems in use.
超声在评估甲状腺结节方面起着至关重要的作用。我们比较了两种最流行的超声恶性肿瘤风险分层系统，即 2015 年美国甲状腺协会（ATA）指南和美国放射学院甲状腺成像和报告数据系统（ACR TI-RADS）。
我们回顾性地从 137 名患者中识别出 250 个经手术切除的甲状腺结节。由 6 名具有超声解释专业知识的评分者分别使用 ATA 和 ACR TI-RADS 独立对其超声图像进行评分。对于每个系统，我们生成了接收者操作特征曲线并计算了曲线下面积（AUC）。
65 个（26%）结节为恶性。对于 ATA 和 ACR TI-RADS，评分者之间存在“适度一致”。我们观察到的 ATA 和 ACR TI-RADS 类别中的恶性风险与预期的风险阈值相似，但也有一些值得注意的例外，包括 ATA 的中级风险类别和 ACR TI-RADS 的三个最高风险类别。根据结节大小和平均 ATA 评分，ATA 指南将对 250 个结节中的 226 个进行活检。根据 ACR TI-RADS，将对 146 个结节进行活检。ATA 的敏感性、特异性、阴性预测值和阳性预测值分别为 92%、10%、79%和 27%，而 ACR TI-RADS 的敏感性、特异性、阴性预测值和阳性预测值分别为 74%、47%、84%和 33%。ATA 的 AUC 为 0.734，而 ACR TI-RADS 的 AUC 为 0.718。
尽管两种系统均表现出良好的诊断性能，但 ATA 指南导致更多的甲状腺活检，并对较高风险类别进行更一致的恶性风险预测。
随着甲状腺结节发病率的上升，准确检测恶性肿瘤对避免良性结节的过度治疗很重要。超声是评估甲状腺结节的关键工具之一，尽管在日常实践中使用了许多不同的超声风险分层系统，但这阻碍了临床协作，并在研究中比较数据。朝着开发通用的甲状腺结节超声恶性肿瘤风险分层系统迈出的第一步是更好地了解当前使用的系统的优缺点。
