Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Am J Otolaryngol. 2020 Nov-Dec;41(6):102625. doi: 10.1016/j.amjoto.2020.102625. Epub 2020 Jun 24.
To compare diagnostic performance and malignancy risk stratification among guidelines set forth by the American Thyroid Association (ATA) in 2015, the American Association of Clinical Endocrinologists (AACE), the American College of Endocrinology (ACE) and the Association Medici Endocrinologi (AME) in 2016, and the American College of Radiology (ACR) in 2017.
The retrospective study was approved by the hospital ethics committee, and the informed consent requirement was waived. From October 2015 to March 2016, a total of 230 patients with 230 consecutive thyroid nodules were enrolled in this study. Each nodule was classified by one junior and one senior radiologist separately according to ACR TI-RADS, AACE/ACE/AME and ATA guidelines. The malignancy diagnostic performance and the number of FNA recommendations were pairwise compared among three guidelines using chi-square tests.
Of the 230 thyroid nodules, 137 were malignant, and 93 were benign. However, 19.6% of the nodules (45 of 230) did not match any pattern using the ATA guidelines but with a high risk of malignancy (68.9%). The ACR TI-RADS derived the highest diagnostic performance, from both junior radiologist (AUC 0.815) and senior radiologist (AUC 0.864). The ACR guidelines also showed the greatest level of sensitivity (junior: 86.1%, senior: 94.9%), compared with AACE/ACE/AME and ATA guidelines. The number of thyroid nodules recommended to fine-needle aspiration (FNA) was the lowest (37.8%, 40.4%) by ACR TI-RADS, and meanwhile, the malignant detection rate within these nodules was highest (64.4%, 68.8%).
The ACR guidelines present a higher level of diagnostic indicators and may offer a meaningful reduction in FNA recommendations with a higher malignancy detection rate.
比较美国甲状腺协会（ATA）2015 年、美国临床内分泌医师协会（AACE）、美国内分泌学会（ACE）和内分泌医师协会（AME）2016 年以及美国放射学会（ACR）2017 年发布的指南在诊断性能和恶性风险分层方面的差异。
本回顾性研究经医院伦理委员会批准，豁免了知情同意书要求。2015 年 10 月至 2016 年 3 月，共纳入 230 例连续 230 个甲状腺结节患者。由 2 名初级和 2 名高级放射科医师分别按照 ACR TI-RADS、AACE/ACE/AME 和 ATA 指南对每个结节进行分类。采用卡方检验对 3 种指南之间的恶性诊断性能和 FNA 推荐数量进行两两比较。
230 个甲状腺结节中，恶性结节 137 个，良性结节 93 个。然而，有 19.6%（230 个中的 45 个）的结节不符合 ATA 指南规定的任何模式，但恶性风险较高（68.9%）。ACR TI-RADS 得出的诊断性能最高，初级放射科医师（AUC 0.815）和高级放射科医师（AUC 0.864）均如此。与 AACE/ACE/AME 和 ATA 指南相比，ACR 指南的灵敏度最高（初级：86.1%，高级：94.9%）。ACR TI-RADS 推荐进行细针抽吸活检（FNA）的甲状腺结节数量最低（37.8%，40.4%），但这些结节中的恶性检出率最高（64.4%，68.8%）。
ACR 指南具有更高的诊断指标水平，可能会降低 FNA 推荐数量，同时提高恶性检出率。
