Hu Lei, Liu Xiao, Pei Chong, Xie Li, He Nianan
Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Department of Respiratory and Critical Care Medicine, The First People's Hospital of Hefei City, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Endocr Connect. 2021 May 10;10(5):492-501. doi: 10.1530/EC-21-0034.
We evaluated the diagnostic accuracy of perinodular stiffness, four risk stratification systems (RSSs) (KWAK-TIRADS, ACR-TIRADS, EU-TIRADS, and C-TIRADS), and the combination of perinodular stiffness and the four RSSs in differentiating malignant from benign thyroid nodules (TNs).
A total of 788 TNs in 726 patients were examined with conventional ultrasound (US) examination and sound touch elastography (STE). All TNs were classified by each of the four RSSs. The stiffness inside (E) the TNs was measured by STE. The stiffness of the 2.0-mm perinodular region (Eshell) was measured with the Shell measurement function of STE. The diagnostic performances of four RSSs, the E values, and the Eshell values were evaluated. All TNs were further divided into subgroups based on size (≤ 10 mm group and > 10 mm group).
Ninety-six TNs were classified as benign and 692 as malignant. Among the single-method approaches, ACR-TIRADS showed the highest AUC (0.77) for differentiating malignant from benign TNs for all TNs included. Eshell showed the highest AUC (0.75) in differentiating malignant from benign TNs for TNs with sizes ≤ 10 mm, and there were no significant differences in AUC among all single methods for diagnosis of TNs with sizes > 10 mm (P > 0.05). The combination of C-TIRADS and Eshell/E yielded the highest AUC for all TNs (0.83) and for TNs with size ≤ 10 mm (0.85) compared with other combinations.
Eshell/E combined with conventional US improves the diagnostic accuracy in TNs and may reduce unnecessary fine-needle aspiration.
我们评估了结节周围硬度、四种风险分层系统（KWAK-TIRADS、ACR-TIRADS、EU-TIRADS和C-TIRADS）以及结节周围硬度与这四种风险分层系统相结合在鉴别甲状腺良恶性结节（TNs）方面的诊断准确性。
对726例患者的788个TNs进行了传统超声（US）检查和声触诊弹性成像（STE）检查。所有TNs均由四种风险分层系统分别进行分类。通过STE测量TNs内部的硬度（E）。使用STE的外壳测量功能测量2.0毫米结节周围区域的硬度（Eshell）。评估了四种风险分层系统、E值和Eshell值的诊断性能。所有TNs根据大小进一步分为亚组（≤10毫米组和>10毫米组）。
96个TNs被分类为良性，692个为恶性。在单一方法中，对于纳入的所有TNs，ACR-TIRADS在鉴别良恶性TNs方面显示出最高的AUC（0.77）。对于大小≤10毫米的TNs，Eshell在鉴别良恶性TNs方面显示出最高的AUC（0.75）；对于大小>10毫米的TNs，所有单一诊断方法的AUC之间无显著差异（P>0.05）。与其他组合相比，C-TIRADS与Eshell/E的组合在所有TNs（0.83）和大小≤10毫米的TNs（0.85）中产生了最高的AUC。
Eshell/E与传统超声相结合可提高TNs的诊断准确性，并可能减少不必要的细针穿刺。
