甲状腺结节超声造影实用报告系统
A Practical CEUS Thyroid Reporting System for Thyroid Nodules.
机构信息
From the Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (J.R., X.X., M.L., W.Z., R.L., P.L., B.O., B.L.), Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation (J.R., X.X., M.L., W.Z., R.L., B.O., B.L.), and Department of Otolaryngology, Head and Neck Surgery (P.L.), No. 33 Yingfeng Rd, Guangzhou 510289, China; Department of Ultrasound, Central People's Hospital of Zhanjiang, Zhanjiang, China (Y.C., Y.X.); and Department of Ultrasound, Affiliated Huadu Hospital of Southern Medical University, Guangzhou 510810, China (H.Z., Q.Y.).
出版信息
Radiology. 2022 Oct;305(1):149-159. doi: 10.1148/radiol.212319. Epub 2022 Jun 14.
Background The role of contrast-enhanced US (CEUS) in reducing unnecessary biopsies of thyroid nodules has received little attention. Purpose To construct and externally validate a thyroid imaging reporting and data system (TI-RADS) based on nonenhanced US and CEUS to stratify the malignancy risk of thyroid nodules. Materials and Methods This retrospective study evaluated 756 patients with 801 thyroid nodules who underwent nonenhanced US, CEUS, and fine-needle aspiration and received a final diagnosis from January 2018 to December 2019. Qualitative US features of the thyroid nodules were analyzed with univariable and multivariable logistic regression to construct a CEUS TI-RADS. The CEUS TI-RADS was validated with use of internal cross-validation and external validation. Results A total of 801 thyroid nodules in 590 female (mean age, 44 years ± 13) and 166 male (mean age, 47 years ± 13 [SD]) patients were included. Independent predictive US features included nodule composition at CEUS, echogenicity, nodule shape, nodule margin, echogenic foci, extrathyroidal extension, enhancement direction, peak intensity, and ring enhancement. The CEUS TI-RADS showed a higher area under the receiver operating characteristic curve of 0.93 (95% CI: 0.92, 0.95; < .001 in comparison with all other systems), a biopsy yield of malignancy of 66% (157 of 239 nodules), and an unnecessary biopsy rate of 34% (82 of 239 nodules). In the external validation, the area under the receiver operating characteristic curve, biopsy yield of malignancy, and unnecessary biopsy rate of CEUS TI-RADS were 0.89 (95% CI: 0.84, 0.92), 61% (65 of 106 nodules), and 39% (41 of 106 nodules) for the first external validation set and 0.90 (95% CI: 0.85, 0.94), 57% (56 of 99 nodules), and 43% (43 of 99 nodules) for the second external validation set. Conclusion A contrast-enhanced US (CEUS) thyroid imaging reporting and data system was created with thyroid nodule malignancy risk stratification according to the simplified regression coefficients of nonenhanced US and qualitative features of CEUS. Clinical trials registration no. ChiCTR2000028712 Published under a CC BY 4.0 license.
背景 对比增强超声（CEUS）在减少甲状腺结节不必要的活检方面的作用尚未得到关注。目的 构建并外部验证一种基于常规超声和 CEUS 的甲状腺影像报告和数据系统（TI-RADS），以分层甲状腺结节的恶性风险。材料与方法 本回顾性研究纳入了 2018 年 1 月至 2019 年 12 月期间接受常规超声、CEUS 和细针抽吸活检并获得最终诊断的 756 例 801 个甲状腺结节患者。使用单变量和多变量逻辑回归分析甲状腺结节的定性超声特征，构建 CEUS TI-RADS。使用内部交叉验证和外部验证对 CEUS TI-RADS 进行验证。结果 本研究共纳入了 590 名女性（平均年龄，44 岁±13 岁）和 166 名男性（平均年龄，47 岁±13 岁[标准差]）患者的 801 个甲状腺结节。独立的预测性超声特征包括 CEUS 下的结节成分、回声、结节形状、结节边缘、回声灶、甲状腺外延伸、增强方向、峰值强度和环状增强。CEUS TI-RADS 的受试者工作特征曲线下面积为 0.93（95%CI：0.92，0.95；<0.001 与所有其他系统相比），恶性活检率为 66%（239 个结节中的 157 个），不必要活检率为 34%（239 个结节中的 82 个）。在外部验证中，CEUS TI-RADS 的受试者工作特征曲线下面积、恶性活检率和不必要活检率在第一个外部验证组中分别为 0.89（95%CI：0.84，0.92）、61%（65 个结节）和 39%（41 个结节），在第二个外部验证组中分别为 0.90（95%CI：0.85，0.94）、57%（56 个结节）和 43%（43 个结节）。结论 根据常规超声和 CEUS 的简化回归系数以及定性特征，创建了一种基于 CEUS 的甲状腺影像报告和数据系统，用于甲状腺结节恶性风险分层。临床试验注册号 ChiCTR2000028712 发表于 CC BY 4.0 许可下。
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