Application effect of TI-RADS classification of thyroid ultrasound in differential diagnosis of benign and malignant nodules in thyroid screening during physical examinations
甲状腺彩超TI-RADS分级在体检人群甲状腺筛查中结节良恶性鉴别诊断的应用效果

摘要

目的 评估甲状腺影像报告与数据系统（TI-RADS）在体检人群甲状腺结节良恶性鉴别诊断中的临床价值。方法 采用回顾性队列研究设计，纳入2023年1月至2024年1月于本院行甲状腺筛查的5296名体检者，依据TI-RADS分级标准对检出结节进行风险分层。以手术病理结果为恶性结节金标准，对有病理活检指征的TI-RADS 4a类及以上结节行病理确诊；2类、3类低危结节按临床诊疗指南判定为良性（无病理活检指征），以此计算TI-RADS分级的诊断性能指标。结果 5296名体检者中，2371人检出甲状腺结节，检出率44.77%，其中女性检出率略高于男性，30岁及以上人群检出率随年龄增长呈上升趋势。检出结节中TI-RADS 2类1622例（68.41%）、3类1290例（54.40%）、4a类130例（5.48%），未检出4b类及以上结节。130例TI-RADS 4a类结节经病理验证，18例确诊恶性，恶性率13.85%。TI-RADS 4a类及以上分级诊断甲状腺恶性结节的敏感度为100.00%，特异度98.79%，准确度98.54%，阳性预测值13.85%。随着TI-RADS分级升高，结节实性成分、低/极低回声、纵横比＞1、边缘不规则、微钙化等恶性超声特征出现率显著增加。结论 TI-RADS分级在体检人群甲状腺结节良恶性鉴别中具有较高的实用价值，100%的敏感度可实现恶性结节无漏诊，高特异度能有效减少低危结节的不必要检查与治疗，优化医疗资源配置。临床可依据TI-RADS分级对体检人群甲状腺结节进行分层管理，为精准制定诊疗方案、早期发现甲状腺癌提供可靠依据。

Abstract

Objective To evaluate the clinical value of thyroid imaging reporting and data system (TI-RADS) classification in the differential diagnosis of benign and malignant thyroid nodules in physical examination population.
Methods A retrospective cohort study was conducted, including 5296 physical examinees who underwent thyroid screening in our hospital from January 2023 to January 2024. The detected nodules were risk-stratified according to TI-RADS classification criteria. Pathological results of surgical resection were used as the gold standard for malignant nodules. TI-RADS category 4a and above nodules with pathological biopsy indications were confirmed by pathology, while TI-RADS category 2 and 3 low-risk nodules were judged as benign according to clinical diagnosis and treatment guidelines (without pathological biopsy indications). The diagnostic performance indexes of TI-RADS classification were calculated based on the above stratified verification method.
Results Among 5296 physical examinees, 2371 were found to have thyroid nodules, with a detection rate of 44.77%. The detection rate in females was slightly higher than that in males, and the detection rate in people aged 30 and above increased with age. Among the detected nodules, there were 1622 cases (68.41%) of TI-RADS category 2, 1290 cases (54.40%) of category 3, 130 cases (5.48%) of category 4a, and no cases of category 4b and above were detected. Among the 130 TI-RADS category 4a nodules verified by pathology, 18 cases were diagnosed as malignant, with a malignant rate of 13.85%. For TI-RADS category 4a and above, the diagnostic sensitivity for thyroid malignant nodules was 100.00%, specificity 98.79%, accuracy 98.54%, and positive predictive value 13.85%. With the increase of TI-RADS grade, the incidence of malignant ultrasonic features such as solid components, hypo/extremely hypoechoic, aspect ratio ＞1, irregular margin and microcalcification of nodules increased significantly.
Conclusion   TI-RADS classification has high practical value in the differential diagnosis of benign and malignant thyroid nodules in physical examination population. The sensitivity of 100% can achieve no missed diagnosis of malignant nodules, and the high specificity can effectively reduce unnecessary examinations and treatments for low-risk nodules and optimize the allocation of medical resources. Clinically, TI-RADS classification can be used for stratified management of thyroid nodules in physical examination population, providing a reliable basis for accurately formulating diagnosis and treatment plans and early detecting thyroid cancer.