比较 ACR 和 Kwak TIRADS 应用 ACR TIRADS 大小阈值对 FNA 的诊断性能。
Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS' size thresholds for FNA.
机构信息
Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea.
Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
出版信息
Eur Radiol. 2021 Jul;31(7):5243-5250. doi: 10.1007/s00330-020-07591-1. Epub 2021 Jan 15.
OBJECTIVE
To investigate the diagnostic performances and unnecessary fine-needle aspiration (FNA) rates of two point-scale based TIRADS and compare them with a modified version using the ACR TIRADS' size thresholds.
METHODS
Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. A total of 2106 thyroid nodules 10 mm or larger in size in 2084 patients with definitive cytopathologic findings were included. Ultrasonography categories were assigned according to each guideline. We applied the ACR TIRADS' size thresholds for FNA to the Kwak TIRADS and defined it as the modified Kwak TIRADS (mKwak TIRADS). Diagnostic performances and unnecessary FNA rates were evaluated for both the original and modified guidelines.
RESULTS
Of the original guidelines, the ACR TIRADS had higher specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant mKwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. The mKwak TIRADS also had a lower unnecessary FNA rate than the ACR TIRADS (54.8% and 56.4%, respectively). The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.
CONCLUSION
The modified Kwak TIRADS incorporating the size thresholds of the ACR TIRADS showed higher diagnostic performance and a lower unnecessary FNA rate than the original point-scale based TIRADS.
KEY POINTS
• Of the original guidelines, the ACR TIRADS had the highest specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). • When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant modified version of Kwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. • The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.
目的
研究两种基于两点刻度的 TIRADS 的诊断性能和不必要的细针抽吸（FNA）率，并将其与使用 ACR TIRADS 大小阈值的改良版本进行比较。
方法
我们的机构审查委员会批准了这项回顾性研究，并豁免了知情同意的要求。共纳入 2084 例有明确细胞学发现的患者中 2106 个大小为 10 毫米或以上的甲状腺结节。超声分类根据每个指南进行分配。我们将 ACR TIRADS 的大小阈值应用于 Kwak TIRADS，并将其定义为改良 Kwak TIRADS（mKwak TIRADS）。评估了原始和改良指南的诊断性能和不必要的 FNA 率。
结果
在原始指南中，ACR TIRADS 的特异性、准确性和受试者工作特征曲线下面积（AUC）分别为 63.1%、68.9%和 0.748。当 ACR TIRADS 的大小阈值应用于 Kwak TIRADS 时，产生的 mKwak TIRADS 的特异性、准确性和 AUC 分别为 64.7%、70.3%和 0.765，高于 ACR TIRADS。mKwak TIRADS 的不必要 FNA 率也低于 ACR TIRADS（分别为 54.8%和 56.4%）。Kwak TIRADS 的假阴性率最低（1.9%）。
结论
纳入 ACR TIRADS 大小阈值的改良 Kwak TIRADS 显示出比原始基于点刻度的 TIRADS 更高的诊断性能和更低的不必要 FNA 率。
关键点
在原始指南中，ACR TIRADS 的特异性、准确性和 AUC 最高（分别为 63.1%、68.9%和 0.748）。
当 ACR TIRADS 的大小阈值应用于 Kwak TIRADS 时，产生的改良 Kwak TIRADS 的特异性、准确性和 AUC 分别为 64.7%、70.3%和 0.765，高于 ACR TIRADS。
Kwak TIRADS 的假阴性率最低（1.9%）。
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