Li Wei, Wang Yueming, Wen Jing, Zhang Lanlan, Sun Yuan
Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China.
Department of Radiology, Xuzhou Central Hospital, Xuzhou, China.
AJR Am J Roentgenol. 2021 Jan;216(1):38-47. doi: 10.2214/AJR.19.22691. Epub 2020 Nov 19.
The objective of our study was to investigate the diagnostic performance of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in the risk stratification of thyroid nodules. A literature search of MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar was performed for articles published before July 31, 2019. We included studies using ACR TI-RADS for stratification of thyroid nodules and cytology results from ultrasound-guided fine-needle aspiration biopsy (FNAB), pathology results from surgical resection of the thyroid, or both FNAB cytology and surgical pathology results as the reference standard. Summary estimates of sensitivity and specificity were calculated with the bivariate random-effects modeling and are visually presented in forest plots. We performed multiple subgroup analyses and meta-regression to explore the effects of various clinical settings. We compared ACR TI-RADS with the American Thyroid Association (ATA) guidelines and Korean Thyroid Imaging Reporting and Data System (TIRADS) in studies providing head-to-head comparison. Sixteen studies with 18,614 patients involving a total of 21,882 nodules, were included. The pooled sensitivity and specificity of ACR TI-RADS were 0.89 (95% CI, 0.81-0.93) and 0.70 (95% CI, 0.60-0.78), respectively. The calculated area under summary ROC curve was 0.86 (95% CI, 0.83-0.89), with a diagnostic odds ratio of 18.46 (95% CI, 9.77-34.88). Meta-regression revealed that patient number was a significant factor for heterogeneity ( = 0.02). Ten studies compared the performance of ACR TI-RADS and ATA guidelines: The pooled sensitivity was 0.83 versus 0.87 ( = 0.5), respectively, and the pooled specificity was 0.69 versus 0.50 ( = 0.1). In six studies providing direct comparison of ACR TI-RADS and Korean TIRADS, the pooled sensitivity was 0.85 versus 0.91 ( = 0.13), and the pooled specificity was 0.57 versus 0.24 ( < 0.001). ACR TI-RADS showed favorable sensitivity and moderate specificity in risk stratification of thyroid nodules. The use of ACR TI-RADS could avoid a large number of unnecessary biopsies, although at the cost of a slight decline in sensitivity.
我们研究的目的是调查美国放射学会（ACR）甲状腺影像报告和数据系统（TI-RADS）在甲状腺结节风险分层中的诊断性能。对MEDLINE、Embase、Cochrane图书馆、科学网和谷歌学术进行文献检索，以查找2019年7月31日前发表的文章。我们纳入了使用ACR TI-RADS对甲状腺结节进行分层的研究，以及超声引导下细针穿刺活检（FNAB）的细胞学结果、甲状腺手术切除的病理结果，或以FNAB细胞学和手术病理结果两者作为参考标准的研究。采用双变量随机效应模型计算敏感性和特异性的汇总估计值，并以森林图直观呈现。我们进行了多项亚组分析和meta回归，以探讨各种临床情况的影响。在提供直接比较的研究中，我们将ACR TI-RADS与美国甲状腺协会（ATA）指南以及韩国甲状腺影像报告和数据系统（TIRADS）进行了比较。纳入了16项研究，涉及18614例患者，共21882个结节。ACR TI-RADS的汇总敏感性和特异性分别为0.89（95%CI，0.81-0.93）和0.70（95%CI，0.60-0.78）。计算得出的汇总ROC曲线下面积为0.86（95%CI，0.83-0.89），诊断比值比为18.46（95%CI，9.77-34.88）。Meta回归显示，患者数量是异质性的一个重要因素（P = 0.02）。10项研究比较了ACR TI-RADS和ATA指南的性能：汇总敏感性分别为0.83和0.87（P = 0.5），汇总特异性分别为0.69和0.50（P = 0.1）。在6项提供ACR TI-RADS和韩国TIRADS直接比较的研究中，汇总敏感性分别为0.85和0.91（P = ），汇总特异性分别为0.57和0.24（P < 0.001）。ACR TI-RADS在甲状腺结节风险分层中显示出良好的敏感性和中等的特异性。使用ACR TI-RADS可以避免大量不必要的活检，尽管代价是敏感性略有下降。
