Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
Br J Radiol. 2020 Jul;93(1111):20190923. doi: 10.1259/bjr.20190923. Epub 2020 Apr 9.
To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3-5 benign and malignant thyroid nodules (≤1 cm).
From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules.
The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (＜0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (＞0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663-0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871-0.961).
CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS.
The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.
评估超声造影在诊断直径≤1cm 的实性、TR3-5 级良性和恶性甲状腺小结节中的应用价值。
本研究回顾性分析了 2016 年 1 月至 2018 年 3 月在上海交通大学附属第六人民医院行超声造影（CEUS）检查并经细针穿刺抽吸活检或甲状腺手术的 154 例患者的 185 个甲状腺结节。采用卡方检验比较良恶性甲状腺结节的 CEUS 特征，并对恶性结节的 CEUS 特征进行赋值评分。根据 2017 年甲状腺影像报告和数据系统（TI-RADS）最新版本评估 CEUS 特征总评分和各结节评分，绘制受试者工作特征曲线比较两者对甲状腺良恶性结节的诊断效能。
甲状腺小结节的增强程度、增强模式、边界、形态和增强均匀性差异均有统计学意义（＜0.05）。良性和恶性甲状腺结节的增强完全程度和增强病灶大小差异无统计学意义（＞0.05）。TI-RADS 分类 TR5 对恶性结节的诊断效能为：敏感度 90.10%，特异度 55.95%，准确度 74.59%，阳性预测值 72.22%，阴性预测值 82.46%（曲线下面积[AUC]为 0.738；95%可信区间[CI]：0.6630.813）。CEUS 定性分析指标总评分的诊断效能为：敏感度 86.13%，特异度 89.29%，准确度 87.57%，阳性预测值 90.63%，阴性预测值 84.27%（AUC=0.916；95%CI：0.8710.961）。
CEUS 定性分析在评估甲状腺小结节的诊断效能方面优于 TI-RADS，CEUS 定性分析对诊断恶性甲状腺结节的特异性明显高于 TI-RADS。
最近的 TI-RADS 版本建议通过超声对甲状腺结节进行恶性分层。本文应用该系统和 CEUS 评估了 185 个结节，并将结果与病理发现进行比较，以评估诊断性能。
