Fine-needle aspiration biopsy of thyroid nodules: performances of ACR TI-RADS and ATA guideline

GAO Luying; DA Wa; ZHANG Bo; LI Xiaoyi; LIAO Quan; MA Liyuan; SHI Xinlong; LIU Ruifeng; XIA Yu; JIANG Yuxin

doi:10.19732/j.cnki.2096-6210.2022.05.003

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Fine-needle aspiration biopsy of thyroid nodules: performances of ACR TI-RADS and ATA guideline

更新时间：2025-12-15

- Fine-needle aspiration biopsy of thyroid nodules: performances of ACR TI-RADS and ATA guideline
- Vol. 31, Issue 5, Pages: 471-476(2022)
- 作者机构：
  
  1. 中国医学科学院北京协和医学院北京协和医院超声医学科疑难重症及罕见病国家重点实验室,北京,100730
  2. 西藏自治区人民医院超声医学科,西藏,拉萨,850001
  3. 中日友好医院超声医学科,北京,100029
  4. 中国医学科学院北京协和医学院北京协和医院基本外科疑难重症及罕见病国家重点实验室,北京,100730
- 作者简介：
- 基金信息：
- DOI：10.19732/j.cnki.2096-6210.2022.05.003
  CLC：
- Published Online：28 October 2022，
  
  Published：28 October 2022
- 稿件说明：
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高璐滢,达娃,张波,等. 甲状腺结节细针穿刺活检：ACR TI-RADS和ATA指南应用比较[J]. 肿瘤影像学, 2022, 31(5): 471-476 https://doi.

org/10.19732/j.cnki.2096-6210.2022.05.003
高璐滢,达娃,张波,等. 甲状腺结节细针穿刺活检：ACR TI-RADS和ATA指南应用比较[J]. 肿瘤影像学, 2022, 31(5): 471-476 https://doi. DOI： 10.19732/j.cnki.2096-6210.2022.05.003.

org/10.19732/j.cnki.2096-6210.2022.05.003 DOI：

摘要

目的：

比较2017年美国放射学会（American College of Radiology，ACR）甲状腺影像报告和数据系统（Thyroid Imaging Reporting and Data System，TI-RADS）和2015年美国甲状腺协会（American Thyroid Association，ATA）指南的甲状腺结节细针穿刺活检（fine-needle aspiration biopsy，FNAB）效能和不必要的活检率。

方法：

回顾并纳入2014年12月2016年1月于北京协和医院手术的甲状腺结节（结节＞1 cm）的患者，共纳入1 427个结节，根据ACR TI-RADS和ATA指南，以术后病理学检查为金标准，计算穿刺效率和不必要的活检率。将ACR TI-RADS建议的FNAB大小阈值应用于ATA指南，以及ATA指南建议的FNAB大小阈值应用于ACR TI-RADS，分析其穿刺效率和不必要的活检率的变化。

结果：

所有甲状腺结节中，恶性组797例，良性组630例。根据指南推荐的阈值，ACR TI-RADS穿刺效能更佳（AUC为0.67

0.57，

＜0.001），特异度更高（42.9%

14.3%，

＜0.05），不必要的活检率更低（33.0%

40.6%，

＜0.001），而ATA指南灵敏度比ACR TI-RADS更高（99.2%

91.7%，

＜0.001）。将ACR TI-RADS建议的FNAB大小阈值应用于ATA指南，不必要的活检率明显降低（31.5%），穿刺效能也显著提高（AUC为0.70，

＜0.01）。

结论：

与ATA指南相比，ACR TI-RADS的穿刺效率高、不必要的活检率低。另外，将ACR TI-RADS建议的穿刺阈值应用于ATA指南，修订后ATA指南显示出更佳的穿刺效能和更低的不必要活检率。

Abstract

Objective:

To compare the unnecessary fine-needle aspiration biopsy (FNAB) rates and performance of FNAB of 2017 American Colle

ge of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and 2015 American Thyroid Association (ATA) guideline for thyroid nodules.

Methods:

All consecutive patients with thyroid nodules ＞1 cm who underwent thyroidectomy at Peking Union Medical College Hospital were retrospectively reviewed from December 2014 to January 2016. According to the ACR TI-RADS and ATA guideline

the performance of FNAB and the rate of unnecessary biopsy were calculated. Final diagnosis of malignancy was based on histopathology. The size threshold suggested by the ACR TI-RADS and ATA guideline for FNAB were applied to the ATA guideline

ACR TI-RADS

respectively.

Results:

Of the 1 427 thyroid nodules

797 were malignant

and 630 were benign. ACR TI-RADS showed better accuracy (AUC: 0.67

0.57;

＜0.001). ACR TI-RADS had a higher specificity (42.9%

14.3%

＜0.05) and lower unnecessary biopsy rate (33.0%

40.6%

＜0.001)

whereas the ATA guideline pattern yielded a higher sensitivity (99.2%

91.7%

＜0.001). Applying the FNAB size threshold recommended by the ACR TI-RADS to the ATA guideline

the unnecessary biopsy rate was significantly decreased (31.5%)

and the performance of FNAB was significantly improved (AUC: 0.70).

Conclusion:

ACR TI-RADS had a higher specificity and lower unnecessary biopsy rate for nodules ＞1 cm compared to ATA guideline pattern. Applying the FNAB size threshold recommended by the ACR TI-RADS to the ATA guideline

the unnecessary biopsy rate was significantly decreased and the performance of FNAB was significantly improved.

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