| 摘要: |
| 目的 探讨细胞学结果为Bethesda Ⅲ类(意义不明确的非典型病变/意义不明确的滤泡性病变)甲状腺良恶性结节的超声特征,以及美国放射学会甲状腺影像报告与数据系统(ACR TI-RADS)在此类结节中的价值。方法 回顾性分析2018.01-2020.06在山西医科大学附属人民医院行甲状腺超声及超声引导下细针穿刺细胞学检查(FNAC)、细胞学结果为Bethesda Ⅲ类并经手术病理证实的175例患者共180个甲状腺结节的临床及超声资料。以手术病理结果为金标准,分为良性组和恶性组。比较良恶性结节的内部成分、回声、边缘、形态及强回声类型,并将有统计学意义的指标纳入多因素Logistic回归分析。采用ACR TI-RADS分级评分系统对每个甲状腺结节进行分级,绘制受试者工作特性(ROC)曲线,计算ACR TI-RADS分级评分系统对Bethesda Ⅲ类甲状腺结节诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值及曲线下面积(AUC)。结果 180例甲状腺结节中,术后病理证实良性结节66例,恶性结节114例。单因素分析显示,良恶性结节内部成分、回声、边缘、形态、强回声类型差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析显示,纵横比＞1、低回声、微钙化及混合钙化是恶性结节的独立危险因素(OR值分别为4.903、4.608、4.458、3.821,均P＜0.05)。Spearman相关性分析显示,随着ACR TI-RADS分级的增加,结节的恶性率明显增加(rs=0.653,P＜0.05)；ACR TI-RADS分级以5为诊断点,诊断Bethesda Ⅲ类甲状腺结节的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为83.3%、80.3%、82.2%、88.0%、73.6%,曲线下面积(AUC)为84.1%。结论 Bethesda Ⅲ类甲状腺良恶性结节的超声特征存在差异,纵横比＞1、低回声、微钙化及混合钙化为恶性结节的独立危险因素；ACR TI-RADS分级评分系统有助于Bethesda Ⅲ类甲状腺结节良恶性的判断,可用于指导临床管理。 |
| 关键词: ACR TI-RADS Bethesda Ⅲ 超声特征 甲状腺结节 |
| DOI： |
| 投稿时间：2020-12-03修订日期：2020-12-03 |
| 基金项目:山西省应用基础研究计划基金 |
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| Bethesda Ⅲ thyroid nodules：ultrasonic characteristics and the value ofthyroid imaging reporting and data system |
| LIU Sha,YAN Jiping,WANG Jinping,LIU Zhilong |
| (Department of Medical Imaging,Shanxi Medical University) |
| Abstract: |
| ABSTRACT Objective To explore the ultrasonic characteristics of Bethesda Ⅲ (atypia of undetermined significance/ follicular lesions of undetermined significance) thyroid nodules，and to observe the value of the American College of Radiology thyroid imaging report and data system (ACR TI-RADS) for benign and malignant Bethesda Ⅲ thyroid nodules. Methods The clinical and ultrasound data of 180 thyroid nodules in 175 patients who underwent thyroid ultrasound and ultrasound-guided FNAC and cytology results of Bethesda Ⅲ and surgery in Affiliated People''s Hospital of Shanxi Medical University from January 2018 to June 2020 were retrospectively analyzed. They were divided into benign group and malignant group according to pathological results. The internal composition, echogenicity, margin, shape, and echogenic foci of benign and malignant nodules were compared, and statistically significant indicators were included in the multivariate logistic regression analysis. Each thyroid nodule was graded by ACR TI-RADS. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and area under curve (AUC) of ACR TI-RADS for Bethesda Ⅲ thyroid nodules were calculated by ROC curve. Results Of the 180 thyroid nodules, 66 cases were benign nodules and 114 cases were malignant nodules. Univariate analysis showed a significant difference in internal composition, echogenicity, margin, shape, and echogenic foci between benign and malignant nodules (all P < 0.05). Multivariate logistic regression analysis showed that taller than wide, hypoechoic, microcalcification and mixed calcification were independent risk factors of malignant nodules (OR = 4.903, 4.608, 4.458, 3.821, all P < 0.05). With the increase of ACR TI-RADS classification, the malignant rate of nodules increases significantly（rs=0.653，P＜0.05）; With ACR TI-RADS 5 as the cut-off point, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value in the diagnosis of Bethesda Ⅲ thyroid nodules are 83.3%, 80.3%, 82.2%, 88.0%, 73.6%, respectively, and the area under the curve (AUC) are 84.1%. Conclusion The ultrasonic characteristics of benign and malignant Bethesda Ⅲ thyroid nodules were different, taller than wide, hypoechoic, microcalcification and mixed calcification were independent risk factors of malignant nodules; ACR TI-RADS can be helpful for distinguishing malignant and benign Bethesda Ⅲ thyroid nodules and can guide clinical management. |
| Key words: ACR TI-RADS Bethesda Ⅲ Ultrasonic characteristics Thyroid nodules |
