基于 2015 年美国甲状腺协会指南的弹性成像技术在诊断高度疑似甲状腺结节中的应用：一项多中心研究。
Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study.
机构信息
Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China.
Department of Diagnostic Ultrasound and The National Key Discipline of Medical Imaging and Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
出版信息
BMC Endocr Disord. 2020 Apr 3;20(1):43. doi: 10.1186/s12902-020-0520-y.
BACKGROUND
An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population.
METHODS
Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy.
RESULTS
Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively).
CONCLUSIONS
Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.
背景
基于 2015 年美国甲状腺协会（ATA）指南，对高度疑似结节进行准确诊断可减少不必要的有创检查。超声弹性成像（UE）是鉴别甲状腺良恶性结节的有用工具。本研究旨在探讨超声弹性成像在中国人中对基于 2015 年 ATA 指南的高度疑似甲状腺结节的诊断效能。
方法
来自中国四个地理区域的 12 家医院对基于 2015 年 ATA 指南具有高度可疑特征的甲状腺结节进行常规超声（US）和超声应变弹性成像（USE）检查。甲状腺结节的细胞学/组织学检查作为参考方法。绘制受试者工作特征（ROC）曲线评估弹性评分（ES）和应变比（SR）的诊断性能。采用 logistic 回归分析确定恶性肿瘤的预测因素。
结果
共有 12 个中心的 1445 个甲状腺结节（834 个恶性，611 个良性）纳入最终分析。ES 和 SR 的曲线下面积分别为 0.828 和 0.732。ES 的灵敏度、特异度、准确度、阳性预测值（PPV）和阴性预测值（NPV）分别为 92.4%、60.7%、79.0%、76.3%和 85.5%，SR 分别为 81.1%、50.1%、68.9%、65.9%和 67.9%。甲状腺影像报告和数据系统（TI-RADS）与 ES 相结合，与单独使用 TI-RADS 相比，灵敏度和 NPV 显著提高（分别为 97.1%和 91.9%）。logistic 回归分析显示微钙化（OR=5.290）、纵横比>1（OR=12.710）、不规则边缘（OR=10.117）、甲状腺外侵犯（ETE；OR=6.412）、ES（OR=3.741）和 SR（OR=1.083）是甲状腺恶性结节的独立预测因素。ES 在结节≥1cm 时的灵敏度、特异度、准确度、PPV 和 NPV 均优于结节<1cm（95.0% vs 90.4%，68.8% vs 56.8%，85.9% vs 74.4%，85.2% vs 69.9%，87.8% vs 84.2%）。
结论
超声弹性成像联合 ES 是评估基于 2015 年 ATA 指南的高度疑似甲状腺结节的一种有价值的工具，尤其是在结节≥1cm 时。
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