Department of Ultrasound, the Jiashan County First People's Hospital, Jiashan County, Zhejiang Province, China.
Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
Clin Hemorheol Microcirc. 2022;80(4):463-471. doi: 10.3233/CH-211304.
To compare the application value of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines in the risk stratification of thyroid isthmic nodules.
A total of 315 patients with thyroid isthmic nodules (315 nodules) confirmed by surgical pathology or fine-needle aspiration biopsy (FNAB) were selected in this retrospective study. The nodules were evaluated and classified according to ACR TI-RADS and the ATA guidelines. Taking pathological results as the reference, receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic capabilities of the ACR TI-RADS and the ATA guidelines for the risk stratification of thyroid isthmic nodules. The unnecessary biopsy rates and false-negative rates were compared.
Multivariate analysis of ultrasonographic features of suspicious malignancies showed that an aspect ratio > 1 was not an independent risk factor for malignant thyroid nodules located in the isthmus (odds ratio: 3.193, 95%confidence interval: 0.882-11.552) (P = 0.077). The area under the ROC curves for diagnosing malignant thyroid nodules located in the isthmus in by the ACR TI-RADS and the ATA guidelines were 0.853 and 0.835, respectively. Under the management recommendations of the ACR TI-RADS and ATA guidelines, the false-negative rates of malignant thyroid nodules were 66.2%(ATA intermediate suspicion), 62.3%(ACR TR 4), 81.8%(ATA high suspicion) and 86.5%(ACR TR 5).
Both the ACR TI-RADS and the ATA guidelines have high diagnostic capabilities for the risk stratification of thyroid isthmic nodules. For ACR TR 4 and 5 and ATA intermediate- and high-suspicion thyroid isthmic nodules with a maximum diameter < 1 cm, the criteria for puncture should be lowered, and FNAB should be done to clarify their diagnosis.
比较美国放射学院（ACR）甲状腺影像报告和数据系统（TI-RADS）与美国甲状腺协会（ATA）指南在甲状腺峡部结节风险分层中的应用价值。
本回顾性研究共纳入 315 例经手术病理或细针抽吸活检（FNAB）证实的甲状腺峡部结节患者（315 个结节）。根据 ACR TI-RADS 和 ATA 指南对结节进行评估和分类。以病理结果为参照，绘制受试者工作特征（ROC）曲线，评价 ACR TI-RADS 和 ATA 指南对甲状腺峡部结节风险分层的诊断能力。比较不必要的活检率和假阴性率。
多因素分析显示，超声可疑恶性特征中纵横比＞1 不是甲状腺峡部恶性结节的独立危险因素（比值比：3.193，95%置信区间：0.882-11.552）（P=0.077）。ACR TI-RADS 和 ATA 指南诊断甲状腺峡部恶性结节的 ROC 曲线下面积分别为 0.853 和 0.835。在 ACR TI-RADS 和 ATA 指南的管理建议下，恶性甲状腺结节的假阴性率分别为 66.2%（ATA 中度可疑）、62.3%（ACR TR 4）、81.8%（ATA 高度可疑）和 86.5%（ACR TR 5）。
ACR TI-RADS 和 ATA 指南对甲状腺峡部结节的风险分层均具有较高的诊断能力。对于直径＜1cm 的 ACR TR 4 和 5 及 ATA 中度和高度可疑甲状腺峡部结节，应降低穿刺标准，行 FNAB 以明确诊断。
