两种TI-RADS分级在良恶性甲状腺结节鉴别诊断中的价值比较

目的 比较ACR TI-RADS与Kwak TI-RADS在甲状腺结节良恶性鉴别中的临床价值。方法 共纳入350例甲状腺结节，其中144例通过手术后病理诊断（41.14%），206例通过穿刺细胞病理诊断（58.86%）。根据超声影像进行ACR TI-RADS分级和Kwak TI-RADS分级，比较两种分级系统的诊断准确性和临床价值。结果 ACR TI-RADS分级和Kwak TI-RADS分级的ROC曲线下面积均为0.879。ACR TI-RADS诊断恶性甲状腺结节最佳阈值为TR5级，TR5级对应诊断敏感性，特异性，阳性预测值，阴性预测值，阳性似然比，阴性似然比，诊断比值比, 约登指数以及诊断准确性为77.3%、89.1%、83.0%、85.1%，7.101、 0.255、27.848、0.664、0.843；而Kwak TI-RADS诊断恶性甲状腺结节最佳阈值为4c级，4c级对应上述指标为84.8%、84.0%、78.3%、89.0%，5.283、0.181、29.265、0.688、0.843。结论 两种超声影像TI-RADS分级在鉴别甲状腺结节良恶性上均有较好的诊断效能；对比Kwak TI-RADS，ACR TI-RADS以TR5级为诊断切点具有更高的诊断特异性和较低的诊断敏感性。

Accuracy of two thyroid imaging,reporting and data systems for differential diagnosis ofbenign and malignant thyroid nodules

Objective To compare the accuracy of two widely used thyroid imaging, reporting and data systems (TI-RADS),namely ACR TI-RADS and Kwak TI-RADS, in the differential diagnosis of benign and malignant thyroid nodules. MethodsWe reviewed the data of 350 thyroid nodules with definite diagnoses by surgical histopathology (n=144, 41.14%) or fine needleaspiration (FNA) cytopathology (n=206, 58.86%). The nodules were graded using ACR TI-RADS and Kwak TI-RADS based onthe ultrasound images, and the diagnostic accuracy of these two systems was evaluated by the area under the receiveroperating characteristic curve (AUC). Results The AUCs of ACR TI-RADS and Kwak TI-RADS were both 0.879. For adifferential diagnosis of the thyroid nodules, ACR TI-RADS had a diagnostic sensitivity, specificity, positive predictive value,negative predictive value, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, Youden’s index andaccuracy of 77.3%, 89.1%, 83.0%, 85.1%, 7.101, 0.255, 27.848, 0.664 and 0.843, respectively, with an optimal threshold of TR5, ascompared with 84.8%, 84.0%, 78.3%, 89.0%, 5.283, 0.181, 29.265, 0.688 and 0.843, respectively, of Kwak TI-RADS, which had anoptimal threshold of 4c. Conclusion Both ACR TI-RADS and Kwak TI-RADS have good performance for differential diagnosisof thyroid nodules, but ACR TI-RADS has a higher specificity and a lower sensitivity compared with Kwak TI-RADS.