Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
Sci Rep. 2020 Jun 30;10(1):10632. doi: 10.1038/s41598-020-67543-z.
We compared the diagnostic performances and unnecessary FNA rates of several guidelines and modified versions using the size threshold of the ACR TIRADS. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent and all methods were performed in accordance with the Declaration of Helsinki. A total of 1,384 thyroid nodules in 1,301 patients with definitive cytopathologic findings were included. US categories were assigned according to each guideline. We applied the size threshold suggested by the ACR TIRADS for FNA to the Kwak, ATA and EU guidelines and defined these modified guidelines as the modified Kwak (mKwak), modified ATA (mATA) and modified EU (mEU) guidelines. Diagnostic performances and unnecessary FNA rates of all guidelines were evaluated. Of 1,384 thyroid nodules, 291 (21%) were malignant. Among the original guidelines, the ACR TIRADS had the highest specificity, accuracy, LR and AUC (62.2%, 66%, 2.128 and 0.713). The mKwak, mATA and mEU guidelines had higher specificity, accuracy, LR and AUC (P < 0.001 for all), and fewer unnecessary FNAs, compared with their original guidelines. Among all original and modified guidelines, the mKwak guideline had the highest specificity, accuracy, LR and AUC (64%, 68.6%, 2.389 and 0.75). The unnecessary FNA rate was the lowest with the mKwak guideline (61.1%). The highest sensitivity was observed with the ATA guideline (98.6%). After incorporating the size threshold of the ACR TIRADS to other TIRADS, all guidelines showed higher diagnostic accuracy and lower unnecessary FNA rates than their original versions. The mKwak guideline showed the best diagnostic performances.
我们比较了使用 ACR TIRADS 大小阈值的几种指南和修改版本的诊断性能和不必要的细针抽吸率。我们的机构审查委员会批准了这项回顾性研究，并免除了知情同意的要求，所有方法均符合赫尔辛基宣言的规定。共纳入 1301 例有明确细胞学结果的患者的 1384 个甲状腺结节。根据每个指南分配 US 类别。我们将 ACR TIRADS 建议的 FNA 大小阈值应用于 Kwak、ATA 和 EU 指南，并将这些修改后的指南定义为修改后的 Kwak（mKwak）、修改后的 ATA（mATA）和修改后的 EU（mEU）指南。评估了所有指南的诊断性能和不必要的 FNA 率。在 1384 个甲状腺结节中，291 个（21%）为恶性。在原始指南中，ACR TIRADS 的特异性、准确性、LR 和 AUC 最高（62.2%、66%、2.128 和 0.713）。mKwak、mATA 和 mEU 指南的特异性、准确性、LR 和 AUC 更高（所有 P<0.001），且不必要的 FNAs 更少，与原始指南相比。在所有原始和修改后的指南中，mKwak 指南的特异性、准确性、LR 和 AUC 最高（64%、68.6%、2.389 和 0.75）。不必要的 FNAs 率最低（61.1%）。ATA 指南的灵敏度最高（98.6%）。将 ACR TIRADS 的大小阈值纳入其他 TIRADS 后，所有指南的诊断准确性均提高，不必要的 FNAs 率均降低，优于原始版本。mKwak 指南的诊断性能最佳。
