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简化版 TI-RADS 对甲状腺恶性结节的诊断性能：与 2017 年 ACR-TI-RADS 和 2020 年 C-TI-RADS 的比较。

Diagnostic performance of simplified TI-RADS for malignant thyroid nodules: comparison with 2017 ACR-TI-RADS and 2020 C-TI-RADS.

机构信息

Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China.

出版信息

Cancer Imaging. 2022 Aug 17;22(1):41. doi: 10.1186/s40644-022-00478-y.

DOI:10.1186/s40644-022-00478-y
PMID:35978376
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9386958/
Abstract

BACKGROUND

The aim of this study is to propose a new TI-RADS and compare it with the American College of Radiology (2017 ACR)-TI-RADS and the 2020 Chinese (2020 C)-TI-RADS.

METHODS

A retrospective analysis of 749 thyroid nodules was performed. Based on the calculated odds ratio of ultrasonic signs between benign and malignant nodules, a new thyroid nodule score and malignancy rate were calculated. A receiver operating characteristic curve was drawn to analyze the new system's effectiveness in the differential diagnosis of benign and malignant thyroid nodules and was compared with the 2020 C-TI-RADS and 2017 ACR-TI-RADS. Five ultrasound physicians with different qualifications graded another 123 thyroid nodules according to the 2017ACR-TI-RADS, 2020 C-TI-RADS, and the newly proposed TI-RADS. Intergroup and intragroup consistency was evaluated using the Kappa test and intraclass correlation coefficient (ICC) test.

RESULTS

  1. The new thyroid nodule score was divided into 0, 1, 2, 3, 4, and 5 points, with malignancy rates of 1.52%, 7.69%, 38.24%, 76.00%, 90.75%, and 93.75%, respectively. Using 3 points as the cutoff value to diagnose benign and malignant thyroid nodules, the sensitivity and specificity were 94.03% and 67.39%, respectively, which were higher than those of the 2017 ACR-TI-RADS and 2020 C-TI-RADS. The simplified TI-RADS, namely, sTI-RADS, was established as follows: sTI-RADS 3 (0 points), malignancy rate < 2%; sTI-RADS 4a (1 point), malignancy rate 2-10%; sTI-RADS 4b (2 points), malignancy rate 10-50%; sTI-RADS 4 (3 points), malignancy rate 50-90%; and sTI-RADS 5 (4 and 5 points), malignancy rate > 90%. 2) Five ultrasound doctors graded thyroid nodules by the 2017 ACR-TI-RADS, 2020C-TI-RADS and sTI-RADS. Intragroup consistency was good among all tests; ICC were 0.86 (0.82-0.90), 0.84 (0.78-0.88), and 0.88 (0.84-0.91), respectively, while only sTI-RADS had good intergroup consistency.

CONCLUSION

In summary, we proposed a new TI-RADS, namely, sTI-RADS, which was obtained using a simple assignment method with higher specificity, accuracy, positive predictive value, and Youden index than the 2017 ACR-TI-RADS and 2020 C-TI-RADS.

摘要

背景

本研究旨在提出一种新的 TI-RADS，并将其与美国放射学院（2017 ACR）-TI-RADS 和 2020 年中国（2020 C）-TI-RADS进行比较。

方法

对 749 个甲状腺结节进行回顾性分析。基于超声征象在良性和恶性结节之间的计算比值比，计算出新的甲状腺结节评分和恶性率。绘制受试者工作特征曲线，分析新系统在鉴别诊断良性和恶性甲状腺结节中的有效性，并与 2020 C-TI-RADS 和 2017 ACR-TI-RADS 进行比较。5 名不同资质的超声医师根据 2017 ACR-TI-RADS、2020 C-TI-RADS 和新提出的 TI-RADS 对另外 123 个甲状腺结节进行分级。使用 Kappa 检验和组内相关系数（ICC）检验评估组间和组内一致性。

结果

1）新的甲状腺结节评分分为 0、1、2、3、4 和 5 分，恶性率分别为 1.52%、7.69%、38.24%、76.00%、90.75%和 93.75%。使用 3 分作为诊断良恶性甲状腺结节的截断值，灵敏度和特异度分别为 94.03%和 67.39%，均高于 2017 ACR-TI-RADS 和 2020 C-TI-RADS。建立了简化的 TI-RADS，即 sTI-RADS：sTI-RADS 3（0 分），恶性率<2%；sTI-RADS 4a（1 分），恶性率 2-10%；sTI-RADS 4b（2 分），恶性率 10-50%；sTI-RADS 4（3 分），恶性率 50-90%；sTI-RADS 5（4 分和 5 分），恶性率>90%。2）5 名超声医生根据 2017 ACR-TI-RADS、2020 C-TI-RADS 和 sTI-RADS 对甲状腺结节进行分级。所有检测的组内一致性均较好；ICC 分别为 0.86（0.82-0.90）、0.84（0.78-0.88）和 0.88（0.84-0.91），而只有 sTI-RADS 具有良好的组间一致性。

结论

总之，我们提出了一种新的 TI-RADS，即 sTI-RADS，它采用了一种简单的赋值方法，与 2017 ACR-TI-RADS 和 2020 C-TI-RADS 相比，具有更高的特异性、准确性、阳性预测值和约登指数。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/30e3c59183a4/40644_2022_478_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/83a7977fbd71/40644_2022_478_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/cbb3fca35e6f/40644_2022_478_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/1a6da7d4cbfa/40644_2022_478_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/81561c24a890/40644_2022_478_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/30e3c59183a4/40644_2022_478_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/83a7977fbd71/40644_2022_478_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/cbb3fca35e6f/40644_2022_478_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/1a6da7d4cbfa/40644_2022_478_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/81561c24a890/40644_2022_478_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7394/9386958/30e3c59183a4/40644_2022_478_Fig5_HTML.jpg

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