Huang Supeng, Meng Ning, Pan Mengting, Yu Bo, Liu Juan, Deng Kailin, Hu Mingrong, Zhou Hongwei, Qin Chao
Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal University Hangzhou, China.
Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal University Hangzhou, China.
Int J Clin Exp Pathol. 2020 May 1;13(5):1159-1168. eCollection 2020.
To explore the value of the KWAK Thyroid Imaging Reporting and Data System (KWAK-TIRADS), elasticity score (ES), and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in the diagnosis of suspicious thyroid nodules.
The study included 392 cases of TI-RADS category 4 thyroid nodules that underwent thyroidectomy between January 2017 and October 2019. All patients underwent ultrasonography, ultrasound elastography, and fine-needle aspiration cytology (FNAC) before surgery. The nodules were classified into different categories based on the KWAK-TIRADS, ES, and BSRTC. Patients were divided into two groups based on postoperative pathological characteristics. The sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic (ROC) curve were calculated. Student's t-test and Pearson chi-square test were used to compare diagnostic performance.
There were 159 patients in the benign group and 233 in the malignant group. The percentage of malignant nodules in KWAK-TIRADS categories 4a, 4b, and 4c were 44.3%, 64.8%, and 92.9%, respectively. The percentages of malignant nodules in ES 2, 3, 4, and 5 were 0%, 37.1%, 93.8%, and 100%, respectively. The percentage of malignant nodules in BSRTC levels I, II, III, IV, V and VI were 57.1%, 2.8%, 9.9%, 76.6%, 99.1%, and 100%, respectively. Among those methods, the BSRTC had better diagnostic efficiency than the KWAK-TIRADS and ES (Sp 81.1%, Se 93.6%, and AUC 0.918, <0.01). Among the combined methods, KWAK-TIRADS+ES+BSRTC was more effective than KWAK-TIRADS+ES, KWAK-TIRADS+BSRTC, and ES+BSRTC (Sp 93.7%, Se 91.4%, and AUC 0.967, <0.01).
The combination of KWAK-TIRADS, ES, and BSRTC can improve the accuracy of identifying category 4 thyroid nodules.
探讨KWAK甲状腺影像报告和数据系统（KWAK-TIRADS）、弹性评分（ES）及甲状腺细胞病理学报告贝塞斯达系统（BSRTC）在可疑甲状腺结节诊断中的价值。
本研究纳入了2017年1月至2019年10月期间接受甲状腺切除术的392例TI-RADS 4类甲状腺结节患者。所有患者在手术前均接受了超声检查、超声弹性成像及细针穿刺细胞学检查（FNAC）。根据KWAK-TIRADS、ES及BSRTC将结节分为不同类别。根据术后病理特征将患者分为两组。计算敏感度（Se）、特异度（Sp）及受试者操作特征（ROC）曲线下面积。采用学生t检验和Pearson卡方检验比较诊断性能。
良性组159例，恶性组233例。KWAK-TIRADS 4a、4b和4c类中恶性结节的比例分别为44.3%、64.8%和92.9%。ES 2、3、4和5类中恶性结节的比例分别为0%、37.1%、93.8%和100%。BSRTC I、II、III、IV、V和VI级中恶性结节的比例分别为57.1%、2.8%、9.9%、76.6%、99.1%和100%。在这些方法中，BSRTC的诊断效率优于KWAK-TIRADS和ES（Sp 81.1%，Se 93.6%，AUC 0.918，P<0.01）。在联合方法中，KWAK-TIRADS+ES+BSRTC比KWAK-TIRADS+ES、KWAK-TIRADS+BSRTC及ES+BSRTC更有效（Sp 93.7%，Se 91.4%，AUC 0.967，P<0.01）。
KWAK-TIRADS、ES及BSRTC联合应用可提高4类甲状腺结节的识别准确性。
