摘要目的 评价Kwak与ACR (2017)甲状腺影像报告和数据系统(TI‐RADS)对甲状腺结节的诊断效能.方法 收集2015年1月至2018年3月的甲状腺结节手术病例,高年资超声医师经过培训后,分别以Kwak和ACR TI‐RADS分类方法回顾性分析甲状腺结节的超声征象.观察甲状腺结节12 712个,最终超声和手术病理资料完整的 7 023 例患者的7 023个结节纳入本研究.以甲状腺结节的实性、低回声或极低回声、纵横比≥1、边缘模糊、微钙化为超声恶性征象,计算恶性百分比,比较两种方法的诊断效能.结果 ①两种T I‐RADS分类在良恶性结节之间差异有统计学意义( P ＜0 .01 ) ;②Kwak和ACR诊断恶性结节的ROC曲线下面积分别为0 .89和0 .84 , Youden指数分别为0 .66和0 .57 ;③以Kwak T I4B和 ACR T R4为恶性的临界点, Kwak T I‐RADS诊断的敏感性、特异性、阳性预测值、阴性预测值分别为 75 .0%、 90 .9%、 83 .2%、 85 .9%,准确性为 84 .9%; ACR TI‐RADS诊断的敏感性、特异性、阳性预测值、阴性预测值分别为 88.2%、68.9%、62.9%、90.8%,准确性为 76.2%;Kwak TI4B和ACR T R4的Kappa值为0 .52 , χ2 ＝2 174 .6 ,P ＜0 .01 .结论 两种 T I‐RADS分类方法对甲状腺恶性结节的诊断价值均较高,Kwak TI‐RADS分类方法整体效能优于ACR TI‐RADS分类.

abstractsObjective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .