ACR TI-RADS预测伴桥本甲状腺炎的甲状腺乳头状癌颈淋巴结转移的价值

目的： 探讨美国放射学会甲状腺影像报告与数据系统（ACR TI RADS）预测伴桥本甲状腺炎（Hashimoto′s thyroiditis,HT）的甲状腺乳头状癌(papillary thyroid carcinoma, PTC)颈淋巴结转移的价值。方法： 回顾性分析271例伴HT的PTC患者,依据有无颈淋巴结转移分为有转移组和无转移组,比较两组患者术前超声声像图表现差异,并根据声像图表现分别进行Kwak甲状腺影像报告与数据系统(Kwak TI RADS)和ACR TI RADS分级,采用二分类Logistic回归分析确定颈淋巴结转移的独立影响因素。绘制肿瘤最大径、纵横比、ACR TI RADS分值的ROC曲线,评估各预测因素的诊断效能。结果： 年龄、性别、肿瘤最大径、纵横比、ACR TI RADS分值与伴HT的PTC患者颈淋巴结转移明显相关（P<0.05）。Logistic回归分析显示: 肿瘤最大径、ACR TI RADS分值、纵横比>1是颈淋巴结转移的独立危险因素（OR分别为1.169、1.392、2.765, P均<0.05）。肿瘤最大径、ACR TI RADS分值、纵横比>1联合预测模型的ROC曲线下面积为0.887（95% CI：0.849～0.925）,敏感性为86.2%,特异性为75.0%。结论：ACR TI RADS分值是伴HT的PTC患者颈淋巴结转移的独立影响因素,与肿瘤最大径、纵>1横比联合预测模型可为临床制定治疗方案提供一定的影像学依据。

The role of ACR TIRADS category in predicting cervical lymph node metastasis

［Abstract］Objective To investigate the value of ACR TI RADS categories in predicting cervical lymph node metastasis in thyroid papillary carcinoma (PTC)patients with Hashimoto′s thyroiditis(HT). Methods A retrospective analysis was performed in 271 PTC patients with HT. They were divided into metastasis group and non metastasis group according to the presence or absence of cervical lymph node metastasis. The differences of preoperative ultrasonography between the two groups were compared, then Kwak TI RADS and ACR TI RADS categories were graded according to the ultrasonography features. Binary logistic regression analysis was performed to determine the independent predictors of cervical lymph node metastasis. The ROC curve was drawn to evaluate the diagnostic efficiency of each factor. Results Age, sex, maximum diameter, aspect ratio, and ACR TI RADS score were correlated with cervical lymph node metastasis in PTC patients with HT (all P<0.05). Binary logistic regression analysis showed that maximum diameter, ACR TI RADS score and aspect ratio>1 were independent factors for predicting cervical lymph node metastasis（OR=1.169,1.392,2.765, all P<0.05）. The area under ROC curve (AUC) of the combined prediction model was 0.887 (95% CI 0.849-0.925), the sensitivity and specificity were 86.2% and 75.0%, respectively. ConclusionACR TI RADS score is the independent predictor of cervical lymph node metastasis in PTC patients with HT. The combined prediction model can provide some imaging references for clinical treatment.