Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.).
Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China (X.J.).
Acad Radiol. 2024 Jan;31(1):131-141. doi: 10.1016/j.acra.2023.04.029. Epub 2023 May 22.
To estimate the diagnostic performance of the currently used ultrasound (US)-based risk stratification systems (RSSs) (American Thyroid Association, American Association of Clinical Endocrinologists, American College of Endocrinology, and Association Medici Endocrinology Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules, European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults [EU-TIRADS], American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS], Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules [C-TIRADS], and Thyroid Imaging Reporting and Data System Developed by Kwak et al [Kwak-TIRADS]) for atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules.
This retrospective study included 514 consecutive AUS/FLUS nodules in 481 patients with final diagnosis. The US characteristics were reviewed and classified using the categories defined by each RSS. The diagnostic performance was evaluated and compared using a generalized estimating equation method.
Of the 514 AUS/FLUS nodules, 148 (28.8%) were malignant and 366 (71.2%) were benign. The calculated malignancy rate increased from the low-risk to high-risk categories for all RSSs (all P < .001). Interobserver correlation for both US features and RSSs showed substantial to almost perfect agreement. The diagnostic efficacy of Kwak-TIRADS (AUC=0.808) and C-TIRADS (AUC=0.804) were similar (P = .721) and higher than those of other RSSs (all P < .05). The EU-TIRADS and Kwak-TIRADS exhibited similar sensitivity (86.5% vs 85.1%, P = .739) and were only higher than that of the C-TIRADS (all P < .05). The specificity of C-TIRADS and ACR-TIRADS were similar (78.1% vs 72.1%, P = .06) and were higher than those of other RSSs (all P < .05).
Currently used RSSs can provide risk stratification for AUS/FLUS nodules. Kwak-TIRADS and C-TIRADS have the highest diagnostic efficacy in identifying malignant AUS/FLUS nodules. A detailed knowledge of the benefits and shortcomings of the various RSSs is essential.
评估目前使用的超声（US）风险分层系统（RSS）（美国甲状腺协会、美国临床内分泌医师协会、美国内分泌学会、内分泌医学协会临床实践甲状腺结节诊断和管理指南、欧洲甲状腺协会成人甲状腺结节恶性超声风险分层指南[EU-TIRADS]、美国放射学会甲状腺成像报告和数据系统[ACR-TIRADS]、中国甲状腺结节超声恶性风险分层指南[C-TIRADS]以及 Kwak 等人制定的甲状腺成像报告和数据系统[Kwak-TIRADS]）对不确定意义的不典型性或滤泡性病变的甲状腺结节（AUS/FLUS）的诊断性能。
本回顾性研究纳入了 481 例患者的 514 个连续 AUS/FLUS 结节，最终诊断结果。使用每个 RSS 定义的类别回顾和分类超声特征。使用广义估计方程方法评估和比较诊断性能。
514 个 AUS/FLUS 结节中，恶性结节 148 个（28.8%），良性结节 366 个（71.2%）。所有 RSS 的低危到高危类别中，恶性率均增加（均 P<0.001）。观察者间对 US 特征和 RSS 的相关性显示出高度到几乎完全一致。Kwak-TIRADS（AUC=0.808）和 C-TIRADS（AUC=0.804）的诊断效能相似（P=0.721），高于其他 RSS（均 P<0.05）。EU-TIRADS 和 Kwak-TIRADS 的敏感性（86.5%与 85.1%，P=0.739）相似，仅高于 C-TIRADS（均 P<0.05）。C-TIRADS 和 ACR-TIRADS 的特异性相似（78.1%与 72.1%，P=0.06），高于其他 RSS（均 P<0.05）。
目前使用的 RSS 可对 AUS/FLUS 结节进行风险分层。Kwak-TIRADS 和 C-TIRADS 在识别恶性 AUS/FLUS 结节方面具有最高的诊断效能。详细了解各种 RSS 的优缺点至关重要。
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