2017年美国放射学会甲状腺影像报告与数据系统鉴别甲状腺良恶性结节

目的 探讨2017年美国放射学会（ACR）推荐的甲状腺影像报告与数据系统（TI-RADS）对鉴别甲状腺良恶性结节的应用价值。方法 回顾性分析经手术病理确诊的497个甲状腺结节的超声资料,采用2017年ACR TI-RADS分类对结节评分和分类,与病理结果对照,采用ROC确定最佳临界评分,计算TI-RADS分类诊断良恶性结节的敏感度、特异度和准确率。评价高年资与低年资医师采用此最佳临界评分诊断甲状腺良恶性结节的效能和一致性。结果 采用2017年ACR TI-RADS分类诊断甲状腺恶性结节的ROC曲线下面积为0.883（P<0.001）,最佳临界评分为5分,敏感度86.22%,特异度78.68%。以TI-RADS评分> 5分归为恶性结节,高年资和低年资医师诊断的敏感度、特异度、准确率分别为78.22%（176/225）、76.47%（208/272）、77.26%（384/497）和77.33%（174/225）、74.26%（202/272）、75.65%（376/497）,二者诊断良恶性结节具有中等一致性（Kappa=0.581）。结论 2017年ACR TI-RADS具有较高临床应用价值,鉴别甲状腺良恶性结节的最佳界值为5分。     

超声TI-RADS分类联合BRAFV600E基因检测在BSRTC Ⅲ类甲状腺结节中的意义

目的探索甲状腺影像报告与数据系统(TI-RADS)联合BRAFV600E对甲状腺细胞病理学Bethesda(BSRTC)分类为Ⅲ类结节的诊断意义。方法选取2018年8月至2020年8月于郑州大学第一附属医院行甲状腺超声引导下细针穿刺(US-FNA)且结果为BSRTC Ⅲ, 共199个结节, 以术后常规病理结果为金标准, 比较TI-RADS、BRAFV600E及两者联合对BSRTC Ⅲ类结节的诊断价值。结果 199个Ⅲ类结节, 术后病理:甲状腺乳头状癌77个, 良性结节122个。TI-RADS分类为4b、4c或5类诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为90.9%、74.5%、69.3%、92.9%、80.9%。BRAFV600E诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为89.6%、98.4%、97.2%、93.8%、95.0%。TIRADS 4b、4c、5类或BRAFV600E阳性为BSRTC Ⅲ类结节恶性的诊断标准, 其敏感度、特异度、阳性预测值、阴性预测值及准确性分别为98.7%、73.8%、70...     

甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用

目的 探讨甲状腺影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)在超声检查甲状腺结节中的诊断价值.方法 收集292例(423个)甲状腺结节患者的超声资料,以组织病理学结果为参照标准,采用TI-RADS分级诊断标准进行回顾性评价.结果 423个甲状腺结节中,TI-RADS分级为1～5级者其恶性结节所占百分率分别为0(0/129)、6.3%(11/176)、33.3%(10/30)、86.8%(46/53)和100%(35/35).对甲状腺良性结节超声检查TI-RADS分级的灵敏度、特异度、正确率、阳性预测值和阴性预测值分别为96.3%(309/321)、83.3%(85/102)、93.1%(394/423)、94.8%(309/326)和87.6%(85/97),阳性似然比、阴性似然比及Youden指数分别为5.77、0.04和79.6%.TI-RADS分级的良、恶性结节在形态、边界、内部回声、回声质地、内部构成和钙化灶方面所占比例的差异均有统计学意义(P<0.001).结论 在甲状腺结节的超声检查中,应用TI-RADS分级诊断标准对临床诊断和治疗具有重要的指导价值.     

甲状腺影像报告与数据系统、声触诊组织量化技术及超声造影鉴别诊断甲状腺结节良恶性

目的探讨甲状腺影像报告与数据系统(TI-RADS)分类、声触诊组织量化(VTQ)技术及CEUS对甲状腺结节良恶性的鉴别诊断价值。方法对66例患者69个结节均于术前进行TI-RADS分类、CEUS,观察并分析其CEUS表现。采用VTQ测定结节剪切波速度(SWV),绘制ROC曲线获得SWV的曲线下面积及最佳临界值。计算3种方法单独及两两联合的敏感度、特异度、阳性预测值、阴性预测值及准确率。结果 69个甲状腺结节中,良性37个,恶性32个。3种方法单独诊断时,VTQ诊断甲状腺恶性结节的敏感度最高[87.50%(28/32)],CEUS特异度最高[91.89%(34/37)],两两联合应用时,VTQ和CEUS联合诊断甲状腺恶性结节的敏感度最高[93.75(30/32)]。SWV以2.55 m/s为最佳临界值,ROC曲线下面积为0.808(P0.01)。结论 3种方法均对诊断甲状腺结节良恶性有一定价值,VTQ联合CEUS的敏感度最高,是鉴别甲状腺结节良恶性的可靠检查手段。     

声触诊组织量化成像技术鉴别诊断甲状腺影像报告和数据系统4类甲状腺结节

目的探讨声触诊组织量化(VTQ)成像技术对甲状腺影像报告和数据系统(TI-RADs)4类结节的良恶性鉴别诊断价值。方法对88个常规超声评价为TI-RADs 4类的甲状腺结节行VTQ检查。比较VTQ与TI-RADs分类的诊断效能。结果 88个TI-RADs 4类甲状腺结节中,良性结节56个,恶性结节32个。以TI-RADs 4b类和4c类诊断为恶性结节,其诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为90.63%(29/32)、57.14%(32/56)、54.72%(29/53)、91.43%(32/35)及69.32%(61/88)。甲状腺恶性结节VTQ值[(3.26±0.94)m/s]明显高于良性结节VTQ值[(2.03±0.61)m/s,t=7.082,P0.001]。VTQ的最佳诊断界值为2.795m/s,其诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为78.13%(25/32)、91.07%(51/56)、83.33%(25/30)、87.93%(51/58)及86.36%(76/88)。VTQ值诊断TI-RADs 4类甲状腺结节良恶性的特异度及阳性预测值明显高于TI-RADs分类(P均0.05)。结论 VTQ技术有助于TI-RADs 4类甲状腺结节的良恶性鉴别诊断,值得临床推广。     

常规超声TI-RADS分级结合造影检测在甲状腺结节诊断中的临床价值

目的探究常规超声TI-RADS分级结合造影检测在诊断甲状腺结节上的临床价值。方法对2016年1月至2018年12月在本院接受影像学检查的60例甲状腺结节患者(甲状腺结节共计73个)的病历资料进行回顾性分析。所有患者均接受常规超声TI-RADS分级以及超声造影检查,以术后病理学诊断结果为准,对比常规超声TI-RADS分级以及结合超声造影在诊断甲状腺结节良恶性上的诊断价值。结果术后病理学结果显示,60例患者共检出良性结节26个,恶性结节47个。TI-RADS联合造影在诊断甲状腺恶性结节上的准确度、敏感度、特异度以及阳性预测值、阴性预测值分别为91.78%、91.49%、96.15%、97.73%和86.21%,均明显高于TI-RADS(分别为75.34%、76.60%、73.08%、83.72%和63.33%),差异有统计学意义(P0.05)。结论常规超声TI-RADS分级联合超声造影在鉴别诊断甲状腺良恶性结节上效果良好,可显著提升甲状腺良恶性结节的诊断效能。     

超声造影鉴别诊断甲状腺良恶性结节

目的探讨CEUS鉴别诊断甲状腺良恶性结节的价值。方法回顾性分析62例患者67个甲状腺结节的CEUS表现。结果甲状腺恶性结节CEUS多表现为不均匀增强、边界不清,甲状腺良性结节多表现为周边环状强化。根据不均匀强化诊断恶性结节的敏感度为86.84%,特异度为44.83%,阳性预测值为67.35%,阴性预测值为72.22%;边界不清诊断恶性结节的敏感度81.58%,特异度65.52%,阳性预测值75.61%,阴性预测值73.08%;环状强化诊断良性结节的敏感度41.38%,特异度97.37%,阳性预测值92.31%,阴性预测值68.52%。结论 CEUS对鉴别诊断甲状腺良恶性结节具有一定价值。     

超声引导下细针穿刺细胞学检查术前评估甲状腺结节

目的探讨超声引导下细针穿刺细胞学检查(UG-FNAB)术前评估甲状腺结节良恶性的价值。方法对870例患者共1 024个常规超声筛选高度可疑恶性的甲状腺结节行UG-FNAB,并与手术病理进行对照研究。结果 1 024个可疑甲状腺恶性结节中,UG-FNAB检查结果阳性结节902个,阴性结节122个。手术病理结果示恶性结节918个,良性结节106个。UG-FNAB诊断结果与手术病理学诊断结果的差异无统计学意义(χ~2=1.263,P=0.261)。UG-FNAB诊断甲状腺结节的敏感度为97.71%(897/918)、特异度为95.28%(101/106)、阳性预测值为99.45%(897/902)、阴性预测值为82.79%(101/122)、准确率为97.46%(998/1 024)。870例UG-FNAB后均未发生严重并发症。结论 UG-FNAB对于术前评估甲状腺结节良恶性具有较高的应用价值。     

甲状腺影像报告和数据系统分级结合超声弹性成像对甲状腺结节的诊断效能

目的探讨甲状腺影像报告和数据系统（Thyroid Imaging Reporting and Data System,TI-RADS）分级结合超声弹性成像对甲状腺结节的诊断效能。方法回顾性收集2014年1～6月期间在四川大学华西医院行超声检查并进行手术的209例甲状腺结节患者（共222个结节）的临床资料,以病理学结果作为金标准,探讨TI-RDAS分级结合超声弹性成像对≤1 cm结节和〉1 cm结节的诊断价值。结果 222个甲状腺结节中,TI-RDAS分级结合超声弹性成像诊断为恶性结节178个,良性结节44个。对于〉1 cm的甲状腺结节,形态不规则（OR=6.376）、存在微钙化灶（OR=21.525）及有被膜浸润（OR=3.852）者的恶性风险高（P〈0.05）;对于≤1 cm的甲状腺结节,纵横比≥1（OR=3.406）和存在被膜浸润（OR=3.922）者的恶性风险高（P〈0.05）,且弹性评分越高,恶性风险越大（OR=1.606,P=0.045）。对于〉1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.3%（59/60）,特异度为68.6%（24/35）,准确率为87.4%（83/95）,阳性预测值为84.3%（59/70）,阴性预测值为96.0%（24/25）,约登指数为66.9%;对于≤1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.5%（67/68）,特异度为30.5%（18/59）,准确率为66.9%（85/127）,阳性预测值为62.0%（67/108）,阴性预测值为94.7%（18/19）,约登指数为29.0%。结论 TI-RADS分级结合超声弹性成像对≤1 cm与〉1 cm甲状腺结节的诊断价值有所不同,但对〉1 cm甲状腺结节其诊断效能更好。     

TI-RADS在甲状腺良恶性结节鉴别诊断中的价值

探讨甲状腺影像学报告及数据系统(TI-RADS)在甲状腺良恶性结节鉴别诊断中的价值。选取2015年1月—2018年12月商丘市第三人民医院治疗的甲状腺结节患者148例,共计甲状腺结节217个,给予超声及弹性成像检查,比较TI-RADS和弹性成像诊断结果。217个病灶中,恶性病灶89个,良性病灶128个;TI-RADS诊断恶性结节的敏感度和准确度分别为70.79%和78.80%,明显低于超声弹性成像的85.39%和88.94%(P0.05);TI-RADS和超声弹性成像诊断恶性结节的特异度比较差异无统计学意义(P0.05);在结节直径≤10 mm患者中,TI-RADS诊断恶性结节的敏感度、特异度和准确度分别为30.43%、73.24%和62.77%,明显低于超声弹性成像的95.65%、98.59%和97.87%(P0.05);在结节直径10 mm患者中,TI-RADS诊断恶性结节的特异度、准确度分别为98.25%和91.06%,明显高于超声弹性成像82.46%和82.11%(P0.05)。与弹性成像相比,TI-RADS在甲状腺良恶性结节诊断中的价值较低,但在直径10 mm结节中,其诊断价值较好。     

超声弹性分级法鉴别诊断甲状腺实性结节的良恶性

目的探讨超声弹性成像分级法在甲状腺实性结节良恶性鉴别诊断中的价值及不同医师之间的诊断一致性。方法 72例(89个)甲状腺实性结节患者接受超声检查,由2名医师以超声弹性成像分级法进行分级,并将分级结果与术后病理结果进行对比研究。结果医师1以超声弹性成像分级法诊断恶性甲状腺结节的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为82.93%(34/41)、83.33%(40/48)、83.15%(74/89)、80.95%(34/42)、85.11%(40/47);医师2分别为85.37%(35/41)、81.25%(39/48)、83.15%(74/89)、79.55%(35/44)、86.67%(39/45)。两名医师诊断一致率为95.55%,Kappa=0.752。结论超声弹性成像分级法对甲状腺实性结节良恶性鉴别诊断具有较好的应用价值,不同医生独立完成弹性成像的一致性较好。     

Who needs a fine-needle biopsy? A comparison of the ATA and ACR TI-RADS guidelines in a single-centre retrospective study

The 2015 American Thyroid Association (ATA) and 2017 American College of Radiology: Thyroid Imaging, Reporting and Data System (ACR TI-RADS) guidelines are two popular guidelines adopted to stratify sonographic risk of malignancy for thyroid nodules, and to select cases for fine-needle aspiration (FNA). To understand the test performance of the two systems in predicting thyroid malignancy, 164 thyroidectomy cases performed in a regional hospital in Hong Kong between January 2021 and June 2022 were reviewed. Sonographic images of the index nodule in each case were retrospectively classified into different risk categories using the ATA and ACR TI-RADS guidelines, respectively, followed by retrieval of cytological and pathological results, for comparison. The index nodule was proven malignant in 26.8% of cases in the final pathology. There was a strong and positive correlation between the ATA and ACR TI-RADS risk categories assignment (r_s = .931, p < .001). Recommending FNA according to the ATA had a better sensitivity for malignancy than using the ACR TI-RADS (81.8% vs 72.7%), at the expense of a lower specificity (10.8% vs 40.8%). The sensitivity for malignancy of both systems could be further improved if all fluorodeoxyglucose (FDG)-avid nodules were investigated with FNA regardless of sonographic features and size. There was a statistically significant association between “nodules with FDG avidity and nodules recommended for FNA by the ACR TI-RADS guideline” and an eventual malignant thyroid nodule (p = .002).     

超声引导下细针穿刺抽吸活检诊断甲状腺结节

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对不同大小甲状腺结节的诊断价值。方法回顾分析在我院接受US-FNAB检查的689例患者736个甲状腺结节,超声测量结节最大径,并将其分为<5mm、5～10mm、>10mm组;对结节US-FNAB细胞学诊断结果与术后病理结果或随访结果进行比较,分析组间差异。结果 736个结节中,细胞学诊断恶性132个,可疑恶性61个,良性476个,不满意44个,不确定23个。经术后病理或临床随访,恶性结节208个,良性结节528个。恶性结节最大径小于良性结节(P<0.001)。5～10mm组结节的细胞学阳性率和实际恶性率均大于<5mm组及>10mm组(P均<0.05)。US-FNAB细胞学诊断甲状腺良恶性结节的敏感度为87.02%(181/208),特异度97.73%(516/528),准确率94.70%(697/736)。不同大小甲状腺结节US-FNAB检查的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率差异均无统计学意义(P均>0.05)。结论 US-FNAB是判断甲状腺结节性质的有效手段,对不同大小结节都有较高诊断价值。     

CEUS判定甲状腺"冷结节"的性质

目的探讨应用CEUS鉴别诊断放射性核素显像表现为＂冷结节＂的甲状腺结节性病变的良恶性的价值。方法回顾性分析115例ECT表现为＂冷结节＂患者的170个甲状腺结节性病变的CEUS表现,判定结节良恶性,并与病理结果相对照。结果 170个甲状腺结节中,39个CEUS表现为不均匀弱增强,诊断为恶性;131个表现为与周围甲状腺实质同步等/高增强或无增强,诊断为良性。CEUS诊断甲状腺恶性结节的敏感度为91.67%（33/36）,特异度为95.52%（128/134）,准确率为94.71%（161/170）。结论 CEUS可用以鉴别诊断放射性核素显像表现为＂冷结节＂的甲状腺结节的良恶性。     

Pediatric adaptions are needed to improve the diagnostic accuracy of thyroid ultrasound using TI-RADS

Background/PurposeThyroid Imaging Reporting and Data System (TI-RADS) is validated in adults but not yet in children. The purpose of this study was to determine the sensitivity, specificity, and accuracy of TI-RADS in predicting thyroid malignancy for pediatric nodules, and to compare the diagnostic accuracy to the current American Thyroid Association (ATA) guidelines.MethodsA single institution retrospective review was performed of patients younger than 21 years who underwent thyroid nodule fine needle aspiration biopsy (FNAB). Two radiologists were blinded to the pathology and independently classified all biopsied thyroid nodules based on TI-RADS. ATA and TI-RADS guidelines were analyzed to determine the diagnostic sensitivity and specificity of both scoring systems.Results115 patients (median age 15.5 years, 90 females) with 138 nodules were scored using TI-RADS. There was moderate inter-rater agreement between radiologists (Kappa = 0.51; p < 0.0001). Evaluating several potential TI-RADS criteria, 23.2%-68.1% of nodules were recommended for FNAB, compared to 82.6% of nodules using ATA guidelines. Using TI-RADS ≥ 3 (without size cutoff) as an indication for FNAB had 100% sensitivity with no missed suspicious or malignant nodules on cytology or pathology.ConclusionsUsing TI-RADS for diagnostic management of pediatric thyroid nodules improves accuracy in predicting malignancy.     

Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

Background/objectiveThe diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm.MethodsThe records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared.ResultsForty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001).ConclusionsPreoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.