多机构甲状腺超声数据库中甲状腺风险分类系统与细针抽吸建议的比较。
Comparison of Thyroid Risk Categorization Systems and Fine-Needle Aspiration Recommendations in a Multi-Institutional Thyroid Ultrasound Registry.
机构信息
Vice-Chair of Radiology, Enterprise Integration and Medical Director, Johns Hopkins Medical Imaging, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
出版信息
J Am Coll Radiol. 2021 Dec;18(12):1605-1613. doi: 10.1016/j.jacr.2021.07.019. Epub 2021 Aug 20.
OBJECTIVES
The aim of this study was to compare how often fine-needle aspiration (FNA) would be recommended for nodules in unselected, low-risk adult patients referred for sonographic evaluation of thyroid nodules by ACR Thyroid Imaging Reporting and Data System (TI-RADS), the American Thyroid Association guidelines (ATA), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), European Thyroid Imaging Reporting and Data System (EU-TIRADS), and Artificial Intelligence Thyroid Imaging Reporting and Data System (AI-TIRADS).
METHODS
Seven practices prospectively submitted thyroid ultrasound reports on adult patients to the ACR Thyroid Imaging Research Registry between October 2018 and March 2020. Data were collected about the sonographic features of each nodule using a structured reporting template with fields for the five ACR TI-RADS ultrasound categories plus maximum nodule size. The nodules were also retrospectively categorized according to criteria from ACR TI-RADS, the ATA, K-TIRADS, EU-TIRADS, and AI-TIRADS to compare FNA recommendation rates.
RESULTS
For 27,933 nodules in 12,208 patients, ACR TI-RADS recommended FNA for 8,128 nodules (29.1%, 95% confidence interval [CI] 0.286-0.296). The ATA guidelines, EU-TIRADS, K-TIRADS, and AI-TIRADS would have recommended FNA for 16,385 (58.7%, 95% CI 0.581-0.592), 10,854 (38.9%, 95% CI 0.383-0.394), 15,917 (57.0%, 95% CI 0.564-0.576), and 7,342 (26.3%, 95% CI 0.258-0.268) nodules, respectively. Recommendation for FNA on TR3 and TR4 nodules was lowest for ACR TI-RADS at 18% and 30%, respectively. ACR TI-RADS categorized more nodules as TR2, which does not require FNA. At the high suspicion level, the FNA rate was similar for all guidelines at 68.7% to 75.5%.
CONCLUSION
ACR TI-RADS recommends 25% to 50% fewer biopsies compared with ATA, EU-TIRADS, and K-TIRADS because of differences in size thresholds and criteria for risk levels.
目的
本研究旨在比较在通过美国放射学院（ACR）甲状腺成像报告和数据系统（TI-RADS）、美国甲状腺协会指南（ATA）、韩国甲状腺成像报告和数据系统（K-TIRADS）、欧洲甲状腺成像报告和数据系统（EU-TIRADS）和人工智能甲状腺成像报告和数据系统（AI-TIRADS）对甲状腺结节进行超声评估的低危成年患者中，ACR TI-RADS、ATA、K-TIRADS、EU-TIRADS 和 AI-TIRADS 对甲状腺结节推荐进行细针穿刺活检（FNA）的频率。
方法
7 家诊所于 2018 年 10 月至 2020 年 3 月期间前瞻性地向 ACR 甲状腺成像研究注册中心提交了成年患者的甲状腺超声报告。使用带有五个 ACR TI-RADS 超声类别字段和最大结节大小字段的结构化报告模板，收集了每个结节的超声特征数据。根据 ACR TI-RADS、ATA、K-TIRADS、EU-TIRADS 和 AI-TIRADS 的标准，对结节进行回顾性分类，以比较 FNA 推荐率。
结果
在 12208 名患者的 27933 个结节中，ACR TI-RADS 建议对 8128 个结节（29.1%，95%置信区间[CI]0.286-0.296）进行 FNA。ATA 指南、EU-TIRADS、K-TIRADS 和 AI-TIRADS 将分别建议对 16385 个（58.7%，95%CI0.581-0.592）、10854 个（38.9%，95%CI0.383-0.394）、15917 个（57.0%，95%CI0.564-0.576）和 7342 个（26.3%，95%CI0.258-0.268）结节进行 FNA。ACR TI-RADS 对 TR3 和 TR4 结节的 FNA 建议率最低，分别为 18%和 30%。ACR TI-RADS 将更多的结节归类为 TR2，这不需要进行 FNA。在高度可疑水平，所有指南的 FNA 率相似，为 68.7%至 75.5%。
结论
由于大小阈值和风险水平标准的差异，与 ATA、EU-TIRADS 和 K-TIRADS 相比，ACR TI-RADS 建议进行 25%至 50%的活检更少。
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