Ma Jian, Zhang Lanlan, Sun Yuan, Zhang Min
Department of Ultrasound, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China.
Department of Pediatric, The Affiliated Yancheng Maternity and Child Health Hospital of Yangzhou University, Yancheng, China.
BMC Med Imaging. 2025 Jul 4;25(1):269. doi: 10.1186/s12880-025-01820-z.
In this study, we aimed to investigate the diagnostic performance of modified thyroid nodule size based on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for the pediatric population.
This retrespective study enrolled patients younger than 21 years who underwent thyroid nodule US examination between January 2021 and June 2024. Thyroid nodules were assessed according to the ACR TI-RADS and the modification of size criteria. The diagnostic performance of sensitivity, specificity, area under the receiver operating characteristic curve (AUC), unnecessary biopsy rates, and missed malignancy rates were calculated and compared.
A total of 204 thyroid nodules were retrospectively included, of them 51 were confirmed malignancies. For ACR TI-RADS, the sensitivity, specificity, and AUC were 76.5% (95% CI 62.5%-87.2%), 75.2% (95% CI 67.5%-81.8%), and 0.825 (95% CI 0.756-0.894), demonstrating moderate diagnostic performance. When applied modified lower nodule size, the sensitivity was improved (82.4%, 95% CI 69.1%-91.6%, and 88.2%, 95% CI 76.1%-95.6%); however, which was at the cost of decreasing specificity (65.4%, 95% CI 57.3%-72.9% and 53.6%, 95% CI 45.4%-61.7%).
ACR TI-RADS demonstrated moderate diagnostic performance in the younger population. Lowering the thyroid nodule size criteria for FNAB leads to a higher detection rate of malignant, however, which at the cost of a significantly increased number of biopsies. Larger multicentric studies are required to customize the recommendation further before it can be accepted and used generally in the pediatric population.
在本研究中，我们旨在探讨基于美国放射学会甲状腺影像报告和数据系统（ACR TI-RADS）修改后的甲状腺结节大小对儿科人群的诊断性能。
这项回顾性研究纳入了2021年1月至2024年6月期间接受甲状腺结节超声检查的21岁以下患者。根据ACR TI-RADS和大小标准的修改对甲状腺结节进行评估。计算并比较敏感性、特异性、受试者操作特征曲线下面积（AUC）、不必要活检率和漏诊恶性率等诊断性能指标。
共回顾性纳入204个甲状腺结节，其中51个被确诊为恶性。对于ACR TI-RADS，敏感性、特异性和AUC分别为76.5%（95%CI 62.5%-87.2%）、75.2%（95%CI 67.5%-81.8%）和0.825（95%CI 0.756-0.894），显示出中等诊断性能。应用修改后的较低结节大小时，敏感性有所提高（分别为82.4%，95%CI 69.1%-91.6%和88.2%，95%CI 76.1%-95.6%）；然而，这是以降低特异性为代价的（分别为65.4%，95%CI 57.3%-72.9%和53.6%，95%CI 45.4%-61.7%）。
ACR TI-RADS在较年轻人群中显示出中等诊断性能。降低细针穿刺活检（FNAB）的甲状腺结节大小标准会导致更高的恶性检出率，然而，这是以活检数量显著增加为代价的。在儿科人群中普遍接受和使用之前，需要更大规模的多中心研究来进一步定制建议。
