【摘要】 目的 评估C-TIRADS、EU-TIRADS、ACR-TIRADS与K-TIRADS对甲状腺结节良恶性的诊断效能，为临床诊疗提供依据。方法 回顾性分析榆林市第一医院2017年1月至2024年2月期间321例接受细针穿刺活检（fineneedle aspiration biopsy,FNAB）或手术的甲状腺结节患者。以组织病理学检查结果为金标准，计算各系统不同类别的恶性率，绘制受试者操作特征（receiver operating characteristics,ROC）曲线，比较曲线下面积（areas under the curve,AUC）、灵敏度、特异度、阳性预测值（positive predictive value,PPV）、阴性预测值（negative predictive value,NPV）。结果 相同TI-RADS系统各分类间的恶性比率比较差异均有统计学意义（P<0.05），呈现明确的恶性风险递增趋势；ACR-TIRADS、EU-TIRADS、K-TIRADS及C-TIRADS诊断恶性甲状腺结节的ROC曲线下面积分别为0.801、0.741、0.795、0.795，其中ACR-TIRADS、C-TIRADS和K-TIRADS的AUC明显高于EU-TIRADS，差异均有统计学意义（P<0.05）;ACR-TIRADS、EU-IRADS、K-TIRADS、C-TIRADS的最佳截断值分别为：5类、4C类、5类、5类。C-TIRADS、K-TIRADS、ACR-TIRADS与EU-TIRADS对于恶性结节诊断的敏感性与特异性有差异，差异均有统计学意义（P<0.05）；结论 在基层社区医院，建议用简洁的K-TIRADS分类系统，而三级综合性医院进行甲状腺结节评估时，建议采用更为精细的C-TIRADS分类系统。对于低风险特征的甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）(1～3类甲状腺结节)，可采用超声定期复查，避免非必要的FNAB。更多还原

【Abstract】 Objective To evaluate the diagnostic efficacy of C-TIRADS, EU-TIRADS, ACR-TIRADS, and KTIRADS for differentiating benign from malignant thyroid nodules, thereby providing evidence for clinical diagnosis and management.Methods A retrospective analysis was conducted on 321 patients with thyroid nodules who underwent fine-needle aspiration biopsy(FNAB) or surgery at First Hospital of Yulin City between January 2017 and February 2024. Using histopathological results as the gold standard, the malignancy rates within each category of the different systems were calculated. Receiver operating characteristic(ROC) curves were plotted, and the areas under the curve(AUC), sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) were compared.Results Significant differences in malignancy rates were observed between categories within the same TI-RADS system(P<0. 05), demonstrating a clear increasing trend in malignancy risk across higher categories. The AUCs for diagnosing malignant thyroid nodules were 0. 801 for ACR-TIRADS, 0. 741 for EU-TIRADS, 0. 795 for K-TIRADS, and 0. 795 for C-TIRADS. The AUCs of ACR-TIRADS, CTIRADS, and K-TIRADS were significantly higher than that of EU-TIRADS(P<0. 05). The optimal cutoff points were category 5 for ACR-TIRADS, category 4C for EU-TIRADS, category 5 for K-TIRADS, and category 5 for CTIRADS. Significant differences were observed in the sensitivity and specificity for diagnosing malignant nodules among C-TIRADS, K-TIRADS, ACR-TIRADS, and EU-TIRADS(P<0. 05).Conclusion K-TIRADS is recommended for primary care settings, while C-TIRADS is preferable for tertiary hospitals. For low-risk papillary thyroid microcarcinomas(PTMC), active ultrasound surveillance may delay FNAB.更多还原