【摘要】 目的：外部验证2020中国超声甲状腺影像报告和数据系统（C-TIRADS）、2017年美国放射学院发布的甲状腺超声影像报告和数据系统（ACR TI-RADS）及Kwak提出的甲状腺影像报告和数据系统（Kwak TI-RADS）在甲状腺结节良恶性鉴别中的效能。方法：回顾性分析经手术病理证实的481例（513个）甲状腺结节（良性307个，恶性206个）的超声图像。统计3种分类的恶性百分比，以手术病理结果为金标准，绘制3种分类的ROC曲线，确定最佳截断值，分析、比较3种分类对甲状腺结节良恶性的鉴别诊断效能。结果：C-TIRADS、ACR TI-RADS及Kwak TI-RADS 3种分类的最佳截断值分别为CTIRADS 4b类、ACR TI-RADS 4类、Kwak TI-RADS 4b类，AUC分别为0.890、0.894、0.897，两两比较差异均无统计学意义（均P> 0.05）；敏感度分别为0.808、0.944、0.901，两两比较，C-TIRADS敏感度略低于ACR TI-RADS及Kwak TI-RADS，差异均有统计学意义（均P<0.05）；特异度分别为0.701、0.591、0.634，两两比较，C-TIRADS比ACR TI-RADS及Kwak TI-RADS分类的特异度更高，差异均有统计学意义（均P<0.05）。结论：3种分类对甲状腺结节良恶性的鉴别均具有较高的诊断效能；ACR TI-RADS分类具有较高的敏感度，但操作较繁琐；C-TIRADS分类较简便，且具有更高的特异度，可在各级医院推广。更多还原

【Abstract】 Objective:To investigate the efficacy of 2020 Chinese Ultrasound Thyroid Imaging Reporting and Data System(C-TIRADS),the TI-RADS issued by the American College of Radiology(ACR) in 2017,and the TI-RADS proposed by Kwak(efficacy of Kwak TI-RADS) in the differentiation of benign and malignant thyroid nodules. Methods:Ultrasound images of 481patients with 513 thyroid nodules(307 benign and 206 malignant) confirmed by surgery and pathology were retrospectively analyzed. The malignant percentages were counted according to the C-TIRADS classification,Kwak TI-RADS and ACR TI-RADS.All of them were based on the surgical pathological results as the golden standard. The ROC curve of the subjects were drawn to determine the best diagnostic cut-off values of the three guidelines. The diagnostic efficacy of three classifications in benign and malignant thyroid nodules were analyzed and compared. Results:In all 513 thyroid nodules,cut-off value of 3 methods was C-TIRADS category 4b,ACR TI-RADS category 4,Kwak TI-RADS category 4b,and the AUC of C-TIRADS,ACR TI-RADS,Kwak TI-RADS classifications were 0.890,0.894,0.897,and there was no significant difference(P> 0.05). The sensitivity of C-TIRADS,ACR TI-RADS,Kwak TI-RADS classifications were 0.808,0.944,0.901,the sensitivity of C-TIRAD was lower than that of ACR TI-RADS and Kwak TI-RADS,and there were significant differences(P<0.05). The specificity of C-TIRADS,ACR TI-RADS,Kwak TI-RADS classifications were 0.701,0.591,0.634,the specificity of C-TIRADS was higher than that of ACR TI-RADS and Kwak TI-RADS,and there were significant differences(P<0.05). Conclusions:The C-TIRADS,Kwak TI-RADS and ACR TI-RADS guidelines have high diagnostic efficacy in the differential diagnosis of benign and malignant thyroid nodules,and the ACR TI-RADS is more complicated,but it has higher sensitivity. C-TIRADS is simpler and has higher specificity,and can be popularized in hospitals at all levels.更多还原