高宽比：一种新定义提高了甲状腺影像报告和数据系统（TIRADS）的特异性。
Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems.
作者信息
Grani Giorgio, Lamartina Livia, Ramundo Valeria, Falcone Rosa, Lomonaco Cristiano, Ciotti Laura, Barone Martina, Maranghi Marianna, Cantisani Vito, Filetti Sebastiano, Durante Cosimo
机构信息
Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
Diagnostic and Ultrasound Innovations Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
出版信息
Eur Thyroid J. 2020 Feb;9(2):85-91. doi: 10.1159/000504219. Epub 2019 Nov 15.
INTRODUCTION
A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. To potentially improve the reliability of the TTW definition, we propose an arbitrary ratio of ≥1.2.
OBJECTIVE
The aim of this study was to estimate the impact of this definition on diagnostic performance.
METHODS
We prospectively analyzed 553 thyroid nodules referred for cytology evaluation at an academic center. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2).
RESULTS
The alternative definition classified fewer nodules as TTW (28, 5.1% vs. 94, 17%). The current and proposed definitions have a sensitivity of 26.2 and 11.9% ( = 0.03) and a specificity of 83.8 and 95.5% ( < 0.001). Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. When applied to sonographic risk stratification systems, however, the proposed definition would increase the number of avoided biopsies (up to 58.2% for ACR TIRADS) and the specificity of all systems, without negative impact on sensitivity or diagnostic odds ratio.
CONCLUSIONS
Re-defining TTW nodules as those with an AP/T ratio ≥1.2 improves this marker's specificity for malignancy. Using this definition in risk stratification systems will increase their specificity, reducing the number of suggested biopsies without significantly diminishing their overall diagnostic performance.
引言
纵横比大于1（TTW）的形态是甲状腺结节的可疑特征，通常定义为前后径/横径（AP/T）比值>1。据报道，在AP直径评估中，观察者内变异性高达18%，这可能导致该特征报告过度。为了潜在地提高TTW定义的可靠性，我们提出一个任意比值≥1.2。
目的
本研究的目的是评估该定义对诊断性能的影响。
方法
我们前瞻性分析了在一个学术中心接受细胞学评估的553个甲状腺结节。在细针穿刺之前，两名检查者共同定义了美国甲状腺协会（ATA）、美国临床内分泌学家协会（AACE）、美国放射学会（ACR TIRADS）、欧洲甲状腺协会（EU-TIRADS）和韩国甲状腺放射学会（K-TIRADS）开发的风险分层系统中考虑的所有超声特征。TTW根据当前定义（AP/T直径比值>1）和一个任意替代定义（AP/T比值>1.2）进行定义。
结果
替代定义将较少的结节分类为TTW（28个，5.1%对94个，17%）。当前定义和提议定义的敏感性分别为26.2%和11.9%（P = 0.03），特异性分别为83.8%和95.5%（P < 0.001）。因此，作为单一特征，任意定义的敏感性较低，特异性较高。然而，当应用于超声风险分层系统时，提议的定义将增加避免活检的数量（ACR TIRADS高达58.2%）以及所有系统的特异性，而不会对敏感性或诊断比值比产生负面影响。
结论
将TTW结节重新定义为AP/T比值≥1.2可提高该标志物对恶性肿瘤的特异性。在风险分层系统中使用该定义将提高其特异性，减少建议活检的数量，而不会显著降低其总体诊断性能。
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