儿童及青少年甲状腺结节分级诊断模型的建立与验证

doi:10.19401/j.cnki.1007-3639.2022.05.004

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (5): 397-403.doi: 10.19401/j.cnki.1007-3639.2022.05.004

儿童及青少年甲状腺结节分级诊断模型的建立与验证

刘佳¹^,²()(), 李广涵³, 高璐滢², 张紫杰¹, 王莹², 熊颖¹, 张波³()()

1.民航总医院超声医学科,北京 100123
2.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,北京 100730
3.中日友好医院超声医学科,北京 100029

收稿日期:2022-02-09 修回日期:2022-05-09 出版日期:2022-05-30 发布日期:2022-06-09
通信作者: 张波 E-mail:513726951@qq.com;thyroidus@163.com
作者简介:刘佳（ORCID: 0000-0002-6934-6179）,硕士,住院医师 E-mail: 513726951@qq.com
张波,中日友好医院超声医学科主任,主任医师,教授,博士研究生导师。中国医师协会超声医师分会浅表超声专业委员会副主任委员,中国临床肿瘤学会甲状腺癌专家委员会副主任委员,北京市抗癌协会甲状腺专业委员会副主任委员,北京女医师协会超声医学专业委员会指导专家、副主任委员,中华医学会北京医学会超声医学分会浅表器官与外周血管超声学组委员。擅长领域：甲状腺疾病的超声诊疗及新技术应用。研究成果：主持国家自然科学基金、北京市自然科学基金、清华大学“211工程”建设项目等17项。以第一作者或通信作者发表相关领域文章70余篇,其中在SCI收录期刊上发表20篇。执笔中英文指南与共识9篇。获2021年度中国研究型医院学会医学研究创新奖一等奖1项,2021年度华夏医学科技奖二等奖1项。2020年获评国之名医之“青年新锐”。

Establishment and test of graded diagnostic model of thyroid cancer in children and adolescents

LIU Jia¹^,²()(), LI Guanghan³, GAO Luying², ZHANG Zijie¹, WANG Ying², XIONG Ying¹, ZHANG Bo³()()

1. Department of Ultrasound, Civil Aviation General Hospital, Beijing 100123, China
2. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
3. Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China

Received:2022-02-09 Revised:2022-05-09 Published:2022-05-30 Online:2022-06-09
Contact: ZHANG Bo E-mail:513726951@qq.com;thyroidus@163.com

摘要/Abstract

摘要：

背景与目的： 儿童及青少年甲状腺癌发病率逐年升高,且有较高的转移率及复发率。如果对儿童应用基于成人特点建立的甲状腺结节诊断标准则往往具有较高的漏诊率、误诊率和不必要活检率,本研究旨在建立儿童及青少年甲状腺结节的声像图分级诊断模型,对比其与美国放射学会（American College of Radiology,ACR）甲状腺影像报告与数据系统（Thyroid Imaging-Reporting and Data System,TI-RADS）的诊断效能。方法： 纳入2000年1月—2017年10月中国医学科学院北京协和医学院北京协和医院收治的144例0~18岁的甲状腺结节患者作为训练集,2015年11月—2022年1月中日友好医院和民航总医院收治的41例0~18岁的甲状腺结节患者作为测试集,以病理学诊断作为金标准,将差异有统计学意义的超声特征进行多因素二元logistic回归分析,建立超声分级诊断模型并将模型带入测试集,比较其与ACR TI-RADS的诊断效能。结果： 训练集中实性、低回声、纵横比≥1、边缘不规则及微钙化等差异均有统计学意义（P<0.05）。Logistic回归分析显示,低回声、实性、边缘不规则及有钙化是诊断儿童及青少年甲状腺癌的独立预测因子。以上述独立预测因子建立超声分级系统,测试集中此分级模型与ACR TI-RADS相比具有更高的诊断准确率（92.7% vs 82.9%）。结论： 以实性、低回声、边缘不规则及微钙化建立的分级诊断模型可用于儿童及青少年甲状腺结节的诊断,与ACR TI-RADS相比,具有更高的诊断准确率。

关键词: 甲状腺癌, 儿童, 青少年, 超声, 分级诊断模型

Abstract:

Background and Purpose: The incidence rate of thyroid cancer in children and adolescents is increasing year by year, and there is a high rate of metastasis and recurrence. The application of diagnostic criteria for thyroid nodules based on adult characteristics in children has a high rate of missed diagnosis rate, misdiagnosis rate and unnecessary biopsy. This study aimed to establish a graded diagnostic model of thyroid nodules in children and adolescents, and to compare its diagnostic efficacy with American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Methods: One Hundred and forty-four patients with thyroid nodules aged 0-18 years in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2000 to October 2017 were included as the training set, and 41 patients with thyroid nodules aged 0-18 years in China-Japan Friendship Hospital and Civil Aviation General Hospital from November 2015 to January 2022 were included as the testing set. Taking pathological diagnosis as the gold standard, the statistically significant ultrasonic characteristics were analyzed by multivariate binary logistic regression. The ultrasonic grading diagnostic model was established and brought into the testing set to compare its diagnostic efficiency with ACR TI-RADS. Results: There was significant difference in solidity, hypoechoic, taller-than-wide shape, irregular edge and microcalcification between the two groups (P<0.05). Logistic regression analysis showed that hypoechoic, solidity, irregular margin and calcification were independent predictors for the diagnosis of thyroid cancer in children and adolescents. When the ultrasonic grade was established based on the above independent predictors, this graded model had higher diagnostic accuracy in the testing set compared with ACR TI-RADS (92.7% vs 82.9%). Conclusion: The graded diagnostic model based on solidity, hypoechoic, irregular margin and microcalcification can be used in the diagnosis of thyroid nodules in children and adolescents. Compared with ACR TI-RADS, it has higher diagnostic accuracy.

Key words: Thyroid cancer, Children, Adolescents, Ultrasound, Graded diagnotic model

中图分类号:

R736.1

刘佳, 李广涵, 高璐滢, 张紫杰, 王莹, 熊颖, 张波. 儿童及青少年甲状腺结节分级诊断模型的建立与验证[J]. 中国癌症杂志, 2022, 32(5): 397-403.

LIU Jia, LI Guanghan, GAO Luying, ZHANG Zijie, WANG Ying, XIONG Ying, ZHANG Bo. Establishment and test of graded diagnostic model of thyroid cancer in children and adolescents[J]. China Oncology, 2022, 32(5): 397-403.

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参考文献 21

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Clinical characteristic	Pathological result		P value
Clinical characteristic	Benign (N=63)	Malignant (N=113)	P value
Age/year median (range)	16 (10-18)	16 (6-18)	0.885
Gender n			0.035
Male	7	28
Female	43	66
Number of nodules n			0.053
Single	22	57
Multiple	28	34
Diffuse calcification	0	3
Diffuse glandular lesions n (%)			0.095
With	23 (36.5)	56 (49.6)
Without	40 (63.5)	57 (50.4)
Size n (%)			0.001
<1 cm	11 (17.5)	27 (23.9)
1-2 cm	9 (14.3)	38 (33.6)
2-3 cm	14 (22.2)	27 (23.9)
>3 cm	29 (46.0)	21 (18.6)

Ultrasonic characteristic	Pathological result		P value
Ultrasonic characteristic	Benign (N=63)	Malignant (N=113)	P value
Composition			<0.010
Solid	18 (28.6)	101 (89.4)
Mixed cystic	45 (71.4)	12 (10.6)
Cystic	0 (0.0)	0 (0.0)
Echogenicity			<0.010
Hyperechoic	15 (23.8)	4 (3.5)
Isoechoic	35 (55.6)	16 (14.2)
Hypoechoic	13 (20.6)	93 (82.3)
Very hypoechoic	0 (0.0)	0 (0.0)
Anechoic	0 (0.0)	0 (0.0)
Margin			<0.010
Rule	57 (90.5)	18 (15.9)
Irregular	6 (9.5)	95 (84.1)
Calcification			<0.010
Microcalcification	0 (0.0)	83 (73.5)
Other calcification	2 (3.2)	1 (0.9)
None	61 (96.8)	29 (25.7)
Shape			<0.026
Wider-than-tall	62 (98.4)	95 (84.1)
Taller-than-wide	1 (1.6)	18 (15.9)

Independent variable	Partial regression coefficient	Standard error	Wals	P value	OR	95% CI
Composition (solid)	1.782	0.594	8.987	0.003	5.942	1.853-19.05
Echogenicity (hypoechoic)	1.414	0.612	5.333	0.021	4.113	1.239-13.66
Margin (irregular)	1.779	0.669	7.067	0.008	5.924	1.596-21.994
Calcification (with calcification)	3.051	0.905	11.356	0.001	21.129	3.584-124.579
Shape (taller-than-wide)	-0.842	1.252	0.452	0.501	0.431	0.037-5.015
Constant	-2.873	0.552	27.071	0.000	0.057	NA

Item	Sensitivity	Specificity	PPV	NPV	Accuracy	Jordan index
Training set
ACR TI-RADS	75.2	96.8	97.7	68.5	83.0	0.72
The graded diagnostic model	83.2	95.2	96.9	75.9	87.5	0.78
Testing set
ACR TI-RADS	73.1	100.0	100.0	68.2	82.9	0.73
The graded diagnostic model	96.2	86.7	92.6	92.9	92.7	0.83

儿童及青少年甲状腺结节分级诊断模型的建立与验证

Establishment and test of graded diagnostic model of thyroid cancer in children and adolescents

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