Li Tingting, Zhang Yongyue, Li Zhiqiang, Mei Fang, Zhai Junsha, Zhang Min, Wang Shumin
Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
Endocrine. 2024 Jul;85(1):295-303. doi: 10.1007/s12020-023-03593-3. Epub 2023 Nov 21.
To explore modified parameters of the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) for evaluating contralateral nodules based on preoperative ultrasound features of papillary thyroid carcinoma (PTC) in the suspected lobe, thus guiding the management of bilateral PTC.
We retrospectively analyzed 389 consecutive patients with PTC (272 in training set, 117 in validation set) who underwent total thyroidectomy from March 2020 to March 2022. According to their postoperative pathological data, the patients were divided into unilateral and bilateral PTC groups. The clinicopathological features and sonographic characteristics of suspected nodules were compared between the groups, and further ultrasonic characteristics of TI-RADS grade (TR grade)-underestimated nodules were analyzed.
Patients with a body mass index of ≥25 kg/m (P < 0.001), multifocality in the suspected lobe (P < 0.001), and TR > 3 isthmus nodules (P = 0.003) tended to have bilateral PTC. After modifying the TI-RADS classification for contralateral nodules using these three parameters, the area under the curve for diagnosing contralateral lesions increased from 0.79 (95% confidence interval, 0.74-0.84) to 0.83 (0.78-0.87) in the training set. The missed diagnosis rate of contralateral PTC decreased in both the training set [21.1% (28/133) to 4.5% (6/133)] and validation set [11.4% (8/70) to 2.9% (2/70)]. Preoperative ultrasound tended to underestimate the contralateral nodules with the presence of cystic components [100% (6/6)] and halo sign [73.3% (11/15)].
The modified TI-RADS classification based on the suspected lobe may facilitate effective preoperative malignant risk stratification of contralateral nodules in bilateral PTC.
基于可疑侧叶甲状腺乳头状癌（PTC）的术前超声特征，探索美国放射学会甲状腺影像报告和数据系统（TI-RADS）的修正参数，以评估对侧结节，从而指导双侧PTC的管理。
我们回顾性分析了2020年3月至2022年3月期间连续接受全甲状腺切除术的389例PTC患者（训练集272例，验证集117例）。根据术后病理数据，将患者分为单侧和双侧PTC组。比较两组可疑结节的临床病理特征和超声特征，并分析TI-RADS分级（TR分级）低估结节的进一步超声特征。
体重指数≥25 kg/m的患者（P<0.001）、可疑侧叶存在多灶性病变的患者（P<0.001）以及TR>3的峡部结节患者（P=0.003）倾向于患有双侧PTC。使用这三个参数对TI-RADS对侧结节分类进行修正后，训练集中诊断对侧病变的曲线下面积从0.79（95%置信区间，0.74-0.84）增加到0.83（0.78-0.87）。训练集[21.1%（28/133）降至4.5%（6/133）]和验证集[11.4%（8/70）降至2.9%（2/70）]中对侧PTC的漏诊率均降低。术前超声往往会低估存在囊性成分[100%（6/6）]和晕环征[73.3%（11/15）]的对侧结节。
基于可疑侧叶的修正TI-RADS分类可能有助于对双侧PTC对侧结节进行有效的术前恶性风险分层。
