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首页> 外文期刊>The Journal of Nuclear Medicine >Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions
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Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

机译：使用甲状腺成像报告和数据系统（Tirads）的甲状腺结节的风险分层：遗迹的甲状腺闪烁扫描增加了错误怀疑病变的速率

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摘要

Thyroid nodules are a common finding, especially in iodine-deficient regions. Ultrasonographic scoring systems such as the Thyroid Imaging Reporting and Data System (TIRADS) are helpful in differentiating between benign and malignant thyroid nodules by offering a risk stratification model. Depending on the constellation or number of suspicious ultrasound features, a fine-needle biopsy is recommended. However, none of the previous TIRADS publications considered the functional status of the nodules. Hyperfunctioning thyroid nodules (HTNs) were presumed to exclude malignancy with a very high negative predictive value. Particularly in regions where the iodine supply is low, most HTNs are seen in patients with normal thyroid-stimulating hormone levels. Therefore, thyroid scintigraphy is essential for the detection of HTNs. We investigated whether TIRADS identifies HTNs as nonsuspicious. Methods: We evaluated 615 HTNs (23.2 +/- 10.0 mm in maximum diameter in 582 patients ([442 women, 57.7 +/- 13.2 y old, and 140 men, 60.1 +/- 12.7 y old) detected by Tc-99m-pertechnetate or I-123 scintigraphy. Before evaluating the scintigraphic appearance, all nodules were analyzed prospectively with sonography, using the TIRADS model referenced in Kwak et al., wherein fine-needle biopsy is recommended for TIRADS 4A or higher. We also investigated 2 subgroups, 42 nodules with available histology and 117 patients with subclinical or overt hyperthyroidism. Results: Whereas 15.9% of the nodules were classified as TIRADS 3 or lower and less than 0.1% as TIRADS 5, most of the nodules were classified as TIRADS 4A (29.3%), 4B (29.3%), or 4C (24.9%). Altogether, more than 80% of the autonomous thyroid nodules were classified as TIRADS 4A or higher, a grade that would result in a recommendation of fine-needle biopsy. Focusing on those 117 HTNs that were already associated with hyperthyroid laboratory values, the rates were similar: 81.2% were categorized as TIRADS 4A or higher (4A, 33.3%; 4B, 29.9%; 4C, 17.1%; 5, 0.9%). In the subgroup of patients who underwent thyroid surgery, all nodules were benign, confirming the known negative predictive value of HTNs with regard to malignancy exclusion. Conclusion: Integration of thyroid scintigraphy into the TIRADS model is essential to prevent unnecessary fine-needle biopsy and thyroid surgery.
机译：甲状腺结节是一种常见的发现，特别是在碘缺陷区域。超声波评分系统，如甲状腺成像报告和数据系统（Tirads）通过提供风险分层模型有助于区分良性和恶性甲状腺结节。根据可疑超声功能的星座或数量，建议使用细针活检。但是，以前的Tirads出版物都没有考虑结节的功能状态。假定甲状腺结节（HTNS）被假定以非常高的负面预测值排除恶性肿瘤。特别是在碘供应低的区域中，在正常的致甲状腺刺激激素水平患者中看到大多数HTN。因此，甲状腺闪烁对于检测HTN是必不可少的。我们调查了Tirads是否将HTN识别为非独立。方法：我们评估了615名HTNS（最大直径在582名患者中的最大直径23.2 +/- 10.0毫米（[442名女性，57.7 +/- 13.2 y老化，140名男子，60.1 +/- 12.7 y旧），TC-99M- Pertechnetate或I-123闪烁图。在评估闪烁的外观之前，使用Kwak等人参考的Tirads模型，预先分析所有结节，其中推荐用于Tirad 4a或更高的细针活检。我们还研究了2个亚组，42种具有可用组织学和117名亚临床或公开甲状腺功能亢进患者的结节。结果：虽然15.9％的结节被分类为Tirads 3或更低，小于0.1％，大部分结节被归类为Tirad 4a（29.3 ％），4b（29.3％）或4℃（24.9％）。完全，超过80％的自主甲状腺结节被归类为tirads 4a或更高，这是一个导致细针活检的推荐的等级。聚焦在已经与甲状腺素杆状物相关联的117个HTNS上RORORATOR值，利率类似：81.2％被分类为Tirads 4a或更高（4a，33.3％; 4B，29.9％; 4C，17.1％; 5,0.9％）。在接受甲状腺手术的患者的亚组中，所有结节都是良性的，证实了HTNS关于恶性排斥的已知负面预测值。结论：将甲状腺闪烁成型到Tirads模型的整合对于防止不必要的细针活检和甲状腺手术是必不可少的。

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