Yang Jingjing, Sun Yu, Li Xingjia, Zhao Yueting, Han Xue, Chen Guofang, Ding Wenbo, Li Ruiping, Wang Jianhua, Xiao Fangsen, Liu Chao, Xu Shuhang
Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China.
Front Oncol. 2022 Oct 20;12:1013410. doi: 10.3389/fonc.2022.1013410. eCollection 2022.
This study aimed to compare the diagnostic performances of six commonly used ultrasound-based risk stratification systems for distinguishing follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC), including the American Thyroid Association Sonographic Pattern System (ATASPS), ultrasound classification systems proposed by American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinology (AACE/ACE/AME), Korean thyroid imaging reporting and data system (K-TIRADS), European Thyroid Association for the imaging reporting and data system (EU-TIRADS), American College of Radiology for the imaging reporting and data system (ACR-TIRADS), and 2020 Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules (C-TIRADS). A total of 225 FTA or FTC patients were retrospectively analyzed, involving 251 thyroid nodules diagnosed by postoperative pathological examinations in three centers from January 2013 to October 2021. The diagnostic performances of six ultrasound-based risk stratification systems for distinguishing FTA from FTC were assessed by plotting the receiver operating characteristic (ROC) curves and compared at different cut-off values. A total of 205 (81.67%) cases of FTA and 46 (18.33%) cases of FTC were involved in the present study. Compared with those of FTA, FTC presented more typical ultrasound features of solid component, hypoechoic, irregular margin and sonographic halo (all <0.001). There were no significant differences in ultrasound features of calcification, shape and comet-tail artifacts between cases of FTA and FTC. There was a significant difference in the category of thyroid nodules assessed by the six ultrasound-based risk stratification systems (<0.001). The areas under the curve (AUCs) of ATASPS, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS in distinguishing FTA from FTC were 0.645, 0.729, 0.766, 0.635, 0.783 and 0.798, respectively. Our study demonstrated that all the six ultrasound-based risk stratification systems present potential in the differential diagnosis of FTA and FTC. Specifically, C-TIRADS exerts the best diagnostic performance among the Chinese patients. ATASPS possesses a high sensitivity, while K-TIRADS possesses a high specificity in distinguishing FTA from FTC.
本研究旨在比较六种常用的基于超声的风险分层系统在鉴别滤泡性甲状腺腺瘤（FTA）与滤泡性甲状腺癌（FTC）方面的诊断性能，这六种系统包括美国甲状腺协会超声图像模式系统（ATASPS）、美国临床内分泌学家协会、美国内分泌学会和意大利内分泌医师协会提出的超声分类系统（AACE/ACE/AME）、韩国甲状腺影像报告和数据系统（K-TIRADS）、欧洲甲状腺协会影像报告和数据系统（EU-TIRADS）、美国放射学会影像报告和数据系统（ACR-TIRADS）以及《2020中国甲状腺结节超声恶性风险分层指南》（C-TIRADS）。对225例FTA或FTC患者进行回顾性分析，纳入2013年1月至2021年10月期间三个中心经术后病理检查确诊的251个甲状腺结节。通过绘制受试者工作特征（ROC）曲线并在不同临界值下进行比较，评估六种基于超声的风险分层系统鉴别FTA与FTC的诊断性能。本研究共纳入205例（81.67%）FTA病例和46例（18.33%）FTC病例。与FTA相比，FTC表现出更多典型的超声特征，如实性成分、低回声、边界不规则及声晕（均P<0.001）。FTA与FTC病例在钙化、形态及彗星尾征等超声特征方面无显著差异。六种基于超声的风险分层系统对甲状腺结节的分类存在显著差异（P<0.001）。ATASPS、AACE/ACE/AME、K-TIRADS、EU-TIRADS、ACR-TIRADS和C-TIRADS鉴别FTA与FTC的曲线下面积（AUC）分别为0.645、0.729、0.766、0.635、0.783和0.798。我们的研究表明，所有六种基于超声的风险分层系统在FTA和FTC的鉴别诊断中均具有潜力。具体而言，C-TIRADS在中国患者中表现出最佳的诊断性能。ATASPS具有较高的敏感性，而K-TIRADS在鉴别FTA与FTC时具有较高的特异性。
