目的 对比分析中国版甲状腺影像报告与数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS)(2023版)与美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Re-porting and Data System,ACR TI-RADS)在桥本甲状腺炎合并甲状腺结节良恶性诊断中的效能及不同年资医生使用同一指南的诊断一致性.方法 回顾性分析2013-06/2024-03月就诊并接受手术的桥本甲状腺炎合并甲状腺结节患者268例.分别由1名低年资超声医师(4年超声工作经验)和1名高年资超声医师(15年超声工作经验)根据C-TIRADS(2023版)和ACR TI-RADS对每个结节进行分类,并与术后病理检查结果对照.计算各分类结节的恶性率、灵敏度、特异度、准确度及Kappa值,绘制受试者工作特征(receiver operating characteristic,ROC)曲线并比较曲线下面积(area un-der the curve,AUC).结果 各类别的甲状腺结节恶性率比较差异均有统计学意义(P均＜0.001).低年资医师应用ACR TI-RADS对桥本甲状腺炎合并甲状腺结节良恶性鉴别诊断的AUC、灵敏度、特异度和准确度分别为0.837、61.97％、91.29％、81.03％,应用 C-TIRADS(2023 版)时分别为 0.869、71.83％、88.26％、82.51％;高年资医师应用ACR TI-RADS对桥本甲状腺炎合并甲状腺结节良恶性鉴别诊断的AUC、灵敏度、特异度和准确度分别为0.884、71.82％、93.18％、85.71％,应用 C-TIRADS(2023 版)时分别为 0.910、80.99％、89.77％、86.70％;不同年资医生应用ACR TI-RADS及C-TIRADS(2023版)两种指南诊断桥本甲状腺炎合并甲状腺结节良恶性效能比较,差异均具有统计学意义(P均＜0.05).ACR TI-RADS的最佳截断值为5类,C-TIRADS(2023版)的最佳截断值为4B类.两名不同年资医生应用ACR TI-RADS、C-TIRADS(2023版)评估桥本甲状腺炎合并甲状腺结节良恶性的Kappa值分别为0.913、0.854,一致性极佳.结论 C-TIRADS(2023版)和ACR TI-RADS对桥本甲状腺炎合并甲状腺结节良恶性的鉴别均具有较高的诊断效能,C-TIRADS(2023版)的诊断效能优于ACR TI-RADS,且使用更加方便、快捷.不同年资医生应用两种指南对桥本甲状腺炎合并甲状腺结节进行分类时一致性极佳.
Differential Diagnosis of Benign and Malignant Thyroid Nodules in the Context of Hashimoto's Thyroiditis:Ultrasonic Clini-cal Application of C-TIRADS(2023 Edition)Guidelines and ACR TI-RADS
Objective To compare the efficacy of Chinese Thyroid Imaging Reporting and Data System(C-TI-RADS)(2023 edition)and American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)in the diagnosis of Hashimoto's thyroiditis with benign and malignant thyroid nodules and the consistency of the same guidelines used by doctors with different years of experience.Methods A total of 268 patients with Hashimoto's thyroid-itis with thyroid nodules who accepted surgery from June 2013 to March 2024 were retrospectively analyzed.Each nodule was graded according to C-TIRADS(2023 edition)and ACR TI-RADS by 1 junior sonographer(with 4 years of ultra-sound working experience)and 1 senior sonographer(with 15 years of ultrasound working experience),respectively,and compared with the pathological results of surgery.Malignant rate,sensitivity,specificity,accuracy and Kappa value of each classification of nodules were calculated,receiver operating characteristic(ROC)curve was drawn and area under the curve(AUC)value was compared.Results There were statistically significant differences in the malignant rates of thyroid nodules in each category(all P＜0.001).The AUC,sensitivity,specificity and accuracy of ACR TI-RADS for junior sonographer in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules were 0.837,61.97％,91.29％and 81.03％respectively.C-TIRADS(2023 editsion)were 0.869,71.83％,88.26％and 82.51％,respectively;the AUC,sensitivity,specificity and accuracy of ACR TI-RADS for senior sonographer in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules were 0.884,71.82％,93.18％and 85.71％,respectively,C-TIRADS(2023 edition)were 0.910,80.99％,89.77％and 86.70％,respectively;there were statistically significant differences in the efficacy of ACR TI-RADS and C-TIRADS(2023 edition)in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules among doctors with different years of experience(all P＜0.05).The optimal cutoff values of ACR TI-RADS and C-TIRADS(2023 edition)were cate-gory 5 and 4B,respectively.The C-TIRADS(2023 edition)and ACR TI-RADS guidelines were used by two doctors with different years of experience to evaluate the benign and malignant characteristics of Hashimoto's thyroiditis combined with thyroid nodules,and the Kappa values were 0.913 and 0.854,respectively,consistency was excellent.Conclusion The C-TIRADS(2023 edition)guideline and the ACR TI-RADS guideline are highly effective in the diagnosis of benign and malignant nodules in the context of Hashimoto's thyroiditis.The diagnostic performance of C-TIRADS(2023 edition)is better than that of ACR TI-RADS,and it is faster and more convenient to use.The application of both guidelines to nod-ules is very consistent with the application of different seniority physicians.
Chinese Thyroid Imaging Reporting and Data SystemAmerican College of Radiology Thyroid Ima-ging Reporting and Data SystemThyroid noduleHashimoto's thyroiditisBenign and malignant discriminationConsis-tency
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