评估北美人群中贝塞斯达3类和4类甲状腺结节恶性程度的“CUT”评分的准确性：一项回顾性研究

Accuracy of the 'CUT' Score for Assessing Malignancy in Bethesda 3 and 4 Thyroid Nodules in North American Population: A Retrospective Study.

作者信息

Shihabi Areej N, Hussein Mohammad, Toraih Eman A, Attia Abdallah S, Youssef Mohanad R, Elnahla Ahmed, Omar Mahmoud, Shama Mohamed, Corsetti Ralph, Kandil Emad

机构信息

Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.

Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

出版信息

Cancer Invest. 2022 Sep;40(8):693-699. doi: 10.1080/07357907.2022.2077956. Epub 2022 Jul 14.

DOI:10.1080/07357907.2022.2077956

PMID:35549502

Abstract

BACKGROUND

The CUT score is a thyroid nodule malignancy risk assessment scoring system intended to guide surgeons in treating Bethesda 3 and 4 thyroid nodules. It is based on clinical (C) and ultrasonographic (U) features and a five-tiered (T) representing cytology.

PURPOSE

Our study aimed to assess the utility of the CUT score in predicting thyroid malignancy in the North American population. The main reason for creating this score is to reduce unnecessary surgeries on these challenging thyroid nodules.

MATERIALS AND METHODS

A retrospective record review study applied the CUT score to 219 Bethesda 3 and 4 thyroid nodules. A total of 203 Bethesda 3 and 16 Bethesda 4 nodules from patients treated between January 2015 and December 2019 at a single institution were assessed. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the CUT diagnostic test. Binary logistic regression analysis was performed. Iteration of analysis was performed after stratification according to body mass index to assess CUT score accuracy in obese and non-obese patients.

RESULTS

Of 219 nodules analyzed, 148 were characterized as benign and 71 as malignant. Prevalence rates of malignancy were 29.6% ( = 60) and 68.8% ( = 11) in Bethesda 3 and 4 nodules, respectively. The mean CU (clinical, ultrasonography) score was 5.35 ± 1.38 in benign nodules versus 4.96 ± 1.5 in malignant nodules ( = 0.08). The area under the curve (AUC = 0.433) for the association of CUT scores with nodule malignancy was not significant ( = 0.13). The CUT score was insignificant as a diagnostic test for nodule malignancy in obese (AUC = 0.45; = 0.72) and non-obese patients (AUC = 0.39; = 0.08).

CONCLUSION

The CUT score did not correlate with preoperative malignancy risk estimates in Bethesda 3 thyroid nodules and, therefore, may have limited utility as a predictor of malignancy in these thyroid nodules.

摘要

背景

CUT评分是一种甲状腺结节恶性风险评估评分系统，旨在指导外科医生治疗贝塞斯达3类和4类甲状腺结节。它基于临床（C）和超声（U）特征以及代表细胞学的五级（T）分类。

目的

我们的研究旨在评估CUT评分在预测北美人群甲状腺恶性肿瘤方面的效用。创建该评分的主要原因是减少对这些具有挑战性的甲状腺结节进行不必要的手术。

材料与方法

一项回顾性记录审查研究将CUT评分应用于219个贝塞斯达3类和4类甲状腺结节。对2015年1月至2019年12月期间在单一机构接受治疗的患者的总共203个贝塞斯达3类结节和16个贝塞斯达4类结节进行了评估。进行了受试者操作特征（ROC）曲线分析以评估CUT诊断测试。进行了二元逻辑回归分析。根据体重指数分层后进行分析迭代，以评估肥胖和非肥胖患者中CUT评分的准确性。

结果

在分析的219个结节中，148个被判定为良性，71个为恶性。贝塞斯达3类和4类结节的恶性患病率分别为29.6%（n = 60）和68.8%（n = 11）。良性结节的平均CU（临床、超声）评分为5.35±1.38，而恶性结节为4.96±1.5（P = 0.08）。CUT评分与结节恶性之间关联的曲线下面积（AUC = 0.433）无统计学意义（P = 0.13）。CUT评分作为肥胖（AUC = 0.45；P = 0.72）和非肥胖患者（AUC = 0.39；P = 0.08）结节恶性的诊断测试无统计学意义。