山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (6): 64-69.doi: 10.6040/j.issn.1671-7554.0.2021.1444
• • 上一篇
杨粒芝,孙霄,商蒙蒙,郭鲁,时丹丹,李杰
YANG Lizhi, SUN Xiao, SHANG Mengmeng, GUO Lu, SHI Dandan, LI Jie
摘要: 目的 构建基于中国版甲状腺影像报告与数据系统(C-TIRADS)列线图模型预测甲状腺结节恶性风险。 方法 收集2020年1月至2021年6月就诊于山东大学齐鲁医院甲状腺外科388例甲状腺结节患者的临床及超声资料,将2020年1月至2020年12月的270例患者作为建模组,2021年1月至2021年6月的118例患者作为验证组,根据术后常规病理结果,建模组分为良性结节组(n=137例)和恶性结节组(n=133例),通过单因素分析和多因素Logistic回归分析筛选出甲状腺恶性结节的独立危险因素,构建甲状腺结节恶性风险预测列线图模型并评价其性能。 结果 多因素Logistic回归分析提示年龄、促甲状腺激素(TSH)、甲状腺球蛋白(TG)以及C-TIRADS分类是甲状腺恶性结节的独立危险因素。基于以上独立危险因素构建的列线图模型,其预测建模组甲状腺恶性结节的受试者工作特征(ROC)曲线下面积(AUC)为0.981(95%CI: 0.967~0.996),验证组使用列线图模型预测甲状腺结节恶性风险的AUC为0.951(95%CI: 0.909~0.992),表明列线图具有出色的预测性能,列线图内部验证的一致性指数(C-index)为0.981,表明列线图的区分度良好。建模组校准曲线接近理想曲线,提示列线图预测甲状腺结节的恶性风险与实际风险间具有较高一致性。 结论 年龄、TSH、TG和C-TIRADS分类是预测甲状腺结节恶性风险的独立危险因素;基于C-TIRADS分类联合临床及血清学特征建立的列线图模型能够实现甲状腺结节恶性风险的个体化精准预测。
中图分类号:
[1] 兰霞斌, 张浩.《2015美国甲状腺学会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读[J]. 中华外科杂志, 2016, 54(3): 172-176. [2] 中华医学会超声医学分会浅表器官和血管学组, 中国甲状腺与乳腺超声人工智能联盟, 詹维伟, 等. 2020甲状腺结节超声恶性危险分层中国指南: C-TIRADS[J]. 中华超声影像学杂志, 2021, 30(3): 185-200. [3] 罗景梅, 冯家钢, 詹东, 等. 甲状腺结节患者临床特征研究[J]. 中国全科医学, 2018, 21(36): 4445-4452. LUO Jingmei, FENG Jiagang, ZHAN Dong, et al. Study on clinical characteristics of thyroid nodules [J]. Chinese General Practice, 2018, 21(36): 4445-4452. [4] 吴伟, 张艳君, 王冰, 等. 术前外周血中性粒细胞与淋巴细胞计数比鉴别甲状腺良恶性结节临床价值研究[J]. 中国实用外科杂志, 2016, 36(2): 227-229. WU Wei, ZHANG Yanjun, WANG Bing, et al. Diagnostic value of preoperative peripheral blood neutrophil to lymphocyte ratio in identification of benign and malignant thyroid nodules [J]. Chinese Journal of Practical Surgery, 2016, 36(2): 227-229. [5] Yildiz S, Eker E, Ozturk M, et al. A comparison of haemogram parameters of patients with thyroid papillary cancer and nodular goiter in Van, Turkey [J]. JPMA J Pak Med Assoc, 2019, 69(11): 1642-1646. [6] 苑丽丽, 朱亚丽, 段崇玲, 等. 甲状腺结节术前检查对其良恶性诊断的预测价值[J]. 国际放射医学核医学杂志, 2020, 44(4): 217-224. YUAN Lili, ZHU Yali, DUAN Chongling, et al. Predictive value of preoperative examination of malignancy of thyroid nodules[J]. International Journal of Radiation Medicine and Nuclear Medicine, 2020, 44(4): 217-224. [7] Tufano RP, Noureldine SI, Angelos P. Incidental thyroid nodules and thyroid cancer: considerations before determining management [J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(6): 566-572. [8] Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management [J]. J Clin Endocrinol Metab, 2009, 94(5): 1748-1751. [9] Kawk JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data systeu for us features of nodules: a step in establishing beuer stratification of cancer risk[J]. Radiology, 2011, 260(3): 892-899. [10] Russ G, Bonnema SJ, Erdogan MF, et al. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS [J]. Eur Thyroid J, 2017, 6(5): 225-237. [11] Tessler FN, Middleton WD, Grant EG, et al. ACR thyroid imaging, reporting and data system(TI-RADS): white paper of the ACR TI-RADS committee [J]. J Am Coll Radiol, 2017, 14(5): 587-595. [12] Nixon IJ, Ganly I, Hann LE, et al. Nomogram for selecting thyroid nodules for ultrasound-guided fine-needle aspiration biopsy based on a quantification of risk of malignancy [J]. Head Neck, 2013, 35(7): 1022-1025. [13] 申学舟, 陈利民, 贺军, 等. 构建甲状腺结节良恶性鉴别的定量列线图模型及与TI-RADS的诊断效能比较[J]. 现代实用医学, 2021, 33(4): 430-432. [14] Yousefi E, Sura GH, Somma J. The gray zone of thyroid nodules: using a nomogram to provide malignancy risk assessment and guide patient management [J]. Cancer Med, 2021, 10(8): 2723-2731. [15] Öcal B, Korkmaz MH, Yi lmazer D, et al. The malignancy risk assessment of cytologically indeterminate thyroid nodules improves markedly by using a predictive model [J]. Eur Thyroid J, 2019, 8(2): 83-89. [16] Chen L, Zhang JX, Meng LC, et al. A new ultrasound nomogram for differentiating benign and malignant thyroid nodules [J]. Clin Endocrinol, 2019, 90(2): 351-359. [17] Liu JF, Ba L, Lv H, et al. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis [J]. Sci Rep, 2016, 6: 38551. doi:10.1038/srep38551. [18] 赵跃, 郭永刚, 孙甲甲, 等. 术前SII、NLR、PLR在分化型甲状腺癌中的诊断价值分析[J]. 兰州大学学报(医学版), 2018, 44(6): 50-56. ZHAO Yue, GUO Yonggang, SUN Jiajia, et al. Diagnostic value of preoperative systemic immune-inflammation index, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in differentiated thyroid carcinoma [J]. Journal of Lanzhou University(Medical Sciences), 2018, 44(6): 50-56. [19] 中国抗癌协会甲状腺癌专业委员会(CATO). 甲状腺癌血清标志物临床应用专家共识(2017版)[J]. 中国肿瘤临床, 2018, 45(1): 7-13. [20] 陈丽霞, 彭玲, 马先福. 糖脂类代谢指标、血清TSH及尿碘对甲状腺癌发生风险的评估作用[J]. 中国医师杂志, 2017, 19(2): 281-283. [21] Guarino E, Tarantini B, Pilli T, et al. Presurgical serum thyroglobulin has no prognostic value in papillary thyroid cancer [J]. Thyroid, 2005, 15(9): 1041-1045. [22] Zhang F, Oluwo O, Castillo FB, et al. Thyroid nodule location on ultrasonography as a predictor of malignancy [J]. Endocr Pract, 2019, 25(2):131-137. [23] Ramundo V, Lamartina L, Falcone R, et al. Is thyroid nodule location associated with malignancy risk? [J]. Ultrason Seoul Korea, 2019, 38(3): 231-235. [24] Jasim S, Baranski TJ, Teefey SA, et al. Investigating the effect of thyroid nodule location on the risk of thyroid cancer [J]. Thyroid, 2020, 30(3): 401-407. [25] 周瑾, 周世崇, 李佳伟, 等. 单灶性甲状腺乳头状癌中央区淋巴结转移危险因素分析[J]. 中华超声影像学杂志, 2019, 28(3): 235-240. ZHOU Jin, ZHOU Shichong, LI Jiawei, et al. Risk factors of central neck lymph node metastasis following solitary papillary thyroid carcinoma [J]. Chinese Journal of Ultrasonography, 2019, 28(3): 235-240. [26] Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer [J]. Thyroid, 2016, 26(1): 1-133. |
[1] | 谢同辉,陈志强,常建华,赵丹文,徐博文,智绪亭. 肝内胆管癌根治性切除术后生存因素分析及列线图的建立[J]. 山东大学学报 (医学版), 2021, 59(4): 93-99. |
[2] | 李进叶,宋歌声,宋吉清,王大伟,靳先文,张成琪. 宝石能谱CT与常规超声对甲状腺结节良恶性诊断价值的对照分析[J]. 山东大学学报(医学版), 2016, 54(3): 81-86. |
[3] | 刘言训, 刘佳, 张涛, 王璐, 薛付忠, 王萍. 基于纵向监测队列的2型糖尿病与甲状腺结节的关联性[J]. 山东大学学报(医学版), 2015, 53(8): 83-86. |
[4] | 何东添, 李晓平, 李尚仁. 多层螺旋CT对比彩色多普勒超声在甲状腺微小结节鉴别诊断中的应用[J]. 山东大学学报(医学版), 2014, 52(Z1): 140-141. |
[5] | 姜丽丽, 马喆, 马楚云, 何远流, 陶国伟, 刘村, 耿群, 汤婷婷, 王音. 声脉冲辐射力成像技术对甲状腺良、恶性结节的鉴别诊断价值[J]. 山东大学学报(医学版), 2014, 52(10): 72-76. |
[6] | 乔令艳1, 宋心红2, 林海燕2, 高聆3, 赵家军1. 健康人群中甲状腺结节患病情况调查[J]. 山东大学学报(医学版), 2010, 48(8): 5-. |
[7] | . 甲状腺结节的临床分析[J]. 山东大学学报(医学版), 2009, 47(8): 14-17. |
|