Seminati Davide, Capitoli Giulia, Leni Davide, Fior Davide, Vacirca Francesco, Di Bella Camillo, Galimberti Stefania, L'Imperio Vincenzo, Pagni Fabio
Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy.
Cancers (Basel). 2021 Oct 29;13(21):5439. doi: 10.3390/cancers13215439.
The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, < 0.0001) and positive predictive values (77.5% vs. 50.7%, < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.
美国放射学会（ACR）和欧洲甲状腺协会（EU）已经提出了两种甲状腺结节分类评分系统。在此，我们比较了这两种系统对甲状腺结节进行细针穿刺活检（FNA）分类的能力，并测试了一种结合超声特征和细胞学检查来检测恶性结节的方法的假定作用。将从435名受试者中获取的480个甲状腺结节的前瞻性系列中，使用ACR和EU甲状腺影像报告和数据系统（TIRADS）获得的分数进行比较，以评估它们在根据最终细胞学诊断进行FNA分类中的表现。将在区分良性结节与恶性结节方面贡献最大的超声特征与细胞学检查相结合，以提高其诊断性能。分别使用ACR和EU - TIRADS评分时，推荐对46.5%和51.9%的结节进行FNA。在预测≥TIR3A/III（SIAPEC/贝塞斯达）结节方面，ACR系统与EU - TIRADS相比具有更高的特异性（59.0%对52.4%，P = 0.0012）。此外，与单独的细胞学检查相比，特定的放射学特征（即回声灶和边缘）与细胞学类别相结合提高了特异性（97.5%对91%，P < 0.0001）和阳性预测值（77.5%对50.7%，P < 0.0001），尤其是在不确定结节（TIR3A/III和TIR3B/IV）的情况下，同时保持了出色的敏感性和阴性预测值。与EU - TIRADS相比，ACR - TIRADS系统在甲状腺结节分类中显示出更高的特异性。使用特定的放射学特征提高了细胞学的诊断能力。
