甲状腺结节超声恶性危险分层中国指南(C-TIRADS)对甲状腺乳头状癌的诊断价值

田猛; 吴秀艳; 蔡雪珍; 陈潇洁; 赵大威; 廖瑞真; 刘舜辉

doi:10.3969/j.issn.2095-5227.2022.08.002

甲状腺结节超声恶性危险分层中国指南(C-TIRADS)对甲状腺乳头状癌的诊断价值

Diagnostic value of Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules (C-TIRADS) in papillary thyroid carcinoma

摘要

摘要:
背景中华医学会超声医学分会浅表器官与血管超声学组于2020年制定了甲状腺结节超声恶性危险分层中国指南(Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules，C-TIRADS)。由于该指南是我国的最新版本，目前少见相关应用研究报道。
目的探讨C-TIRADS分类对甲状腺乳头状癌的诊断价值。
方法选择2017年1月 - 2021年6月于联勤保障部队第909医院行手术切除且病理证实的甲状腺良性结节和乳头状癌患者各225例，分为甲状腺良性结节(benign thyroid nodule，BTN)组和甲状腺乳头状癌(papillary thyroid carcinoma，PTC)组，分别对两组甲状腺结节进行声像图特征回顾分析和C-TIRADS分类，并与病理结果进行对照，构建ROC曲线评价该分类方法对甲状腺乳头状癌的诊断效能。
结果 PTC组女性比例明显高于BTN组78.22%(176/225) vs 69.33% (156/225)，P=0.032，患病年龄明显小于BTN组Md(IQR)：46(36 ~ 54)岁 vs 50(44 ~ 58)岁，P＜0.001，结节单发的比例明显高于BTN组60.44%(136/225) vs 39.11%(88/225)，P＜0.001。BTN多见于双侧45.78%(103/225)，PTC多见于右侧46.67%(105/225)。PTC组实性(96.01% vs 36.04%)、边缘模糊/不规则或甲状腺外侵犯(71.38% vs 9.31%)、、垂直位(40.22% vs 2.10%)、极低回声(40.22% vs 2.10%)、微钙化(65.22% vs 6.31%)的比例显著高于BTN组(P均＜0.001)。C-TIRADS分类恶性率：C-TR2为0，C-TR3为2.19%，C-TR4a为16.35%，C-TR4b为57.32%，C-TR4c为95.71%，C-A-TR5为100%；PTC组4a、4b、4c和5类的占比明显高于BTN组，而2、3类的占比明显低于BTN组(P＜0.001)。C-TIRADS分类诊断甲状腺乳头状癌的ROC曲线下面积为0.937，Youden指数最大值对应C-TIRADS的最佳截断值为4b类，其敏感度、特异性、准确性分别为0.924(255/276)、0.868(289/333)、0.893(544/609)。
结论 C-TIRADS分类对甲状腺乳头状癌有较高的诊断效能，且对阴性指标和阳性指标的定义更明确，受超声医师的临床经验影响更小，有很高的临床应用价值。

Abstract:
Background Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules (C-TIRADS) are developed by Superficial Organ and Vascular Ultrasound Group of Ultrasound Medical Society of Chinese Medical Association in 2020. As the guideline is the latest version in China, there are few reports about its clinical application.
Objective To evaluate the diagnostic value of C-TIRADS classification for papillary thyroid carcinoma.
Methods A total of 450 patients with benign thyroid nodule (n=225) or papillary carcinoma (n=225) who underwent surgical resection verified by pathology examination in the 909 Hospital of the Joint Logistic Support Force from January 2017 to June 2021 were selected and divided into benign thyroid nodule group (BTN) and papillary thyroid carcinoma group (PTC). The sonographic characteristics of thyroid nodule and C-TIRADS classification of thyroid nodule in the two groups were reviewed and compared with pathological results. ROC curve was constructed to evaluate the diagnostic efficacy of this classification method for papillary thyroid carcinoma.
Results The proportion of women in the PTC group was significantly higher than that in the BTN group (78.22% 176/225 vs 69.33% 156/225, P=0.032). The age of the PTC group was significantly younger than that of the BTN group (46 36-54 years vs 50 44-58 years, P<0.001. The proportion of single nodules in the PTC group was significantly higher than that in the BTN group (60.44% 136/225 vs 39.11% 88/225, P<0.001). BTN was more common on both sides (45.78% 103/225), while PTC was more common on the right side (46.67% 105/225). The proportion of solid (96.01% vs 36.04%), borderline blurred/irregular or extra-thyroid invasion (71.38% vs 9.31%), vertical position (40.22% vs 2.10%), extremely hypoechoic (8.70% vs 0.60%) and microcalcification (65.22% vs 6.31%) in the PTC group was significantly higher than that in the BTN group (all P<0.001). The malignant rates of C-TIRADS were 0 for C-TR2, 2.19% for C-TR3, 16.35% for C-TR4a, 57.32% for C-TR4b, 95.71% for C-TR4c, 100% for C-TR5. The proportion of 4a, 4b, 4c and 5 in the PTC group was significantly higher than that in the BTN group, while the proportion of 2 and 3 in the PTC group was significantly lower than that in the BTN group (P<0.001). The area under ROC curve of C-TIRADS for the classification and diagnosis of papillary thyroid carcinoma was 0.937 and the optimal cut-off value corresponding to the maximum of Youden index was 4b for C-TIRADS. Its sensitivity, specificity, and accuracy were 0.924 (255/276), 0.868 (289/333), 0.893 (544/609), respectively.
Conclusion C-TIRADS classification has higher diagnostic efficiency for papillary thyroid carcinoma, and the definition of negative and positive indicators is clearer, which is less affected by the clinical experience of sonographers, and has high clinical application value.

HTML全文

参考文献(20)

施引文献

资源附件(0)