Jiang Shan, Xie Qingji, Li Nan, Chen Haizhen, Chen Xi
Department of Vascular Thyroid Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China.
Department of Surgery, Ruijin Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Mol Biosci. 2021 Nov 26;8:752417. doi: 10.3389/fmolb.2021.752417. eCollection 2021.
To assess the malignancy risk of thyroid nodules, ten ultrasound characteristics are suggested as key diagnostic markers. The European Thyroid Association Guidelines (EU-TIRADS) and 2015 American Thyroid Association Management Guidelines (2015ATA) are mainly used for ultrasound malignancy risk stratification, but both are less accurate and do not appropriatetly classify high risk patients in clinical examination. Previous studies focus on papillary thyroid carcinoma (PTC), but follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC) remained to be characterized. Thus, this study aimed to determine the diagnostic accuracy and establish models using all ultrasound features including the nodule size for predicting the malignancy of thyroid nodules (PTC, FTC, and MTC) in China. We applied logistic regression to the data of 1,500 patients who received medical treatment in Shanghai and Fujian. Ultrasound features including taller-than-wide shape and invasion of the thyroid capsule showed high odds ratio (OR 19.329 and 4.672) for PTC in this dataset. Invasion of the thyroid also showed the highest odds ratio (OR = 8.10) for MTC. For FTC, the halo sign has the highest odds ratio (OR = 13.40). Four ultrasound features revealed distinct OR in PTC nodule groups with different sizes. In this study, we constructed a logistic model with accuracy up to 80%. In addition, this model revealed more accuracy than TIRADS in 4b and 4c category nodules. Hence, this model could well predict malignancy in small nodules and classify high-risk patients.
为评估甲状腺结节的恶性风险，建议将十种超声特征作为关键诊断标志物。欧洲甲状腺协会指南（EU-TIRADS）和2015年美国甲状腺协会管理指南（2015ATA）主要用于超声恶性风险分层，但两者准确性均较低，在临床检查中对高风险患者的分类并不恰当。以往研究主要聚焦于甲状腺乳头状癌（PTC），但甲状腺滤泡状癌（FTC）和甲状腺髓样癌（MTC）仍有待进一步明确特征。因此，本研究旨在确定诊断准确性，并利用包括结节大小在内的所有超声特征建立模型，以预测中国甲状腺结节（PTC、FTC和MTC）的恶性程度。我们对在上海和福建接受治疗的1500例患者的数据应用了逻辑回归分析。在该数据集中，超声特征如纵横比大于1和甲状腺被膜侵犯对PTC显示出高优势比（OR分别为19.329和4.672）。甲状腺被膜侵犯对MTC也显示出最高优势比（OR = 8.10）。对于FTC，晕环征具有最高优势比（OR = 13.40）。四种超声特征在不同大小的PTC结节组中显示出明显的优势比。在本研究中，我们构建了一个准确性高达80%的逻辑模型。此外，该模型在4b和4c类结节中显示出比TIRADS更高的准确性。因此，该模型能够很好地预测小结节的恶性程度并对高风险患者进行分类。
