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; 李广涵; 高璐滢; 张紫杰; 王莹; 熊颖; 张波

doi:10.19401/j.cnki.1007-3639.2022.05.004

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儿童及青少年甲状腺结节分级诊断模型的建立与验证

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- 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
- 中国癌症杂志 2022年32卷第5期页码：397-403
- 作者机构：
  
  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
- 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”。" ]
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.05.004
  中图分类号： R736.1
- 收稿：2022-02-09，
  
  修回：2022-05-09，
  
  纸质出版：2022-05-30
- 稿件说明：
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刘佳, 李广涵, 高璐滢, 等. 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.

Jia LIU, Guanghan LI, Luying GAO, et al. Establishment and test of graded diagnostic model of thyroid cancer in children and adolescents[J]. China Oncology, 2022, 32(5): 397-403.
刘佳, 李广涵, 高璐滢, 等. 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. DOI： 10.19401/j.cnki.1007-3639.2022.05.004.

Jia LIU, Guanghan LI, Luying GAO, et al. Establishment and test of graded diagnostic model of thyroid cancer in children and adolescents[J]. China Oncology, 2022, 32(5): 397-403. DOI： 10.19401/j.cnki.1007-3639.2022.05.004.

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

#x02014;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

#x02014;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

#x02265;1、边缘不规则及微钙化等差异均有统计学意义（

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%

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。

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 diagno

sis 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 (

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%

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.

关键词

Keywords

references

SIEGEL R L , MILLER K D , JEMAL A . Cancer statistics, 2018 [J ] . CA A Cancer J Clin , 2018 , 68 ( 1 ): 7 - 30 . DOI: 10.3322/caac.21442 http://doi.org/10.3322/caac.21442 http://doi.wiley.com/10.3322/caac.21442 http://doi.wiley.com/10.3322/caac.21442

国家儿童医学中心 , 国家儿童肿瘤监测中心 , 中华医学会小儿外科学分会 , 等 . 中国儿童甲状腺结节及分化型甲状腺癌专家共识 [J ] . 中华实用儿科临床杂志 , 2020 , 35 ( 20 ): 1521 - 1530 .

National Center for Children’s Health , National Children’s Cancer Surveillance Center , Pediatric Surgery Branch of Chinese Medical Association , et al . Expert consensus on thyroid nodules and differentiated thyroid cancer for Chinese children [J ] . Chin J Appl Clin Pediatr , 2020 , 35 ( 20 ): 1521 - 1530 .

王嘉丽 , 任潇亚 , 倪鑫 , 等 . 儿童甲状腺癌62例临床分析 [J ] . 中华儿科杂志 , 2018 , 56 ( 8 ): 597 - 600 .

WANG J L , REN X Y , NI X , et al . Clinical analysis of thyroid cancer in 62 children [J ] . Chin J Pediatr , 2018 , 56 ( 8 ): 597 - 600 .

RIVKEES S A , MAZZAFERRI E L , VERBURG F A , et al . The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy [J ] . Endocr Rev , 2011 , 32 ( 6 ): 798 - 826 . DOI: 10.1210/er.2011-0011 http://doi.org/10.1210/er.2011-0011 https://academic.oup.com/edrv/article/32/6/798/2354768 https://academic.oup.com/edrv/article/32/6/798/2354768

HAUGEN B R , ALEXANDER E K , BIBLE K C , 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 . DOI: 10.1089/thy.2015.0020 http://doi.org/10.1089/thy.2015.0020 https://www.liebertpub.com/doi/10.1089/thy.2015.0020 https://www.liebertpub.com/doi/10.1089/thy.2015.0020

TESSLER F N , MIDDLETON W D , GRANT E G , 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 . DOI: 10.1016/j.jacr.2017.01.046 http://doi.org/10.1016/j.jacr.2017.01.046 https://linkinghub.elsevier.com/retrieve/pii/S1546144017301862 https://linkinghub.elsevier.com/retrieve/pii/S1546144017301862

KIM P H , YOON H M , HWANG J , et al . Diagnostic performance of adult-based ATA and ACR TI-RADS ultrasound risk stratification systems in pediatric thyroid nodules: a systematic review and meta-analysis [J ] . Eur Radiol , 2021 , 31 ( 10 ): 7450 - 7463 . DOI: 10.1007/s00330-021-07908-8 http://doi.org/10.1007/s00330-021-07908-8 https://doi.org/10.1007/s00330-021-07908-8 https://doi.org/10.1007/s00330-021-07908-8

PICCARDO A , FIZ F , BOTTONI G , et al . Facing thyroid nodules in paediatric patients previously treated with radiotherapy for non-thyroidal cancers: are adult ultrasound risk stratification systems reliable? [J ] . Cancers , 2021 , 13 ( 18 ): 4692 . DOI: 10.3390/cancers13184692 http://doi.org/10.3390/cancers13184692 https://www.mdpi.com/2072-6694/13/18/4692 https://www.mdpi.com/2072-6694/13/18/4692

LIM-DUNHAM J E . Ultrasound guidelines for pediatric thyroid nodules: proceeding with caution [J ] . Pediatr Radiol , 2019 , 49 ( 7 ): 851 - 853 . DOI: 10.1007/s00247-019-04391-8 http://doi.org/10.1007/s00247-019-04391-8 https://doi.org/10.1007/s00247-019-04391-8 https://doi.org/10.1007/s00247-019-04391-8

LIM-DUNHAM J E , TOSLAK I E , REITER M P , et al . Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System for thyroid nodule malignancy risk stratification in a pediatric population [J ] . Am J Roentgenol , 2019 , 212 ( 1 ): 188 - 194 . DOI: 10.2214/AJR.18.20099 http://doi.org/10.2214/AJR.18.20099 https://www.ajronline.org/doi/10.2214/AJR.18.20099 https://www.ajronline.org/doi/10.2214/AJR.18.20099

GUPTA A , LY S , CASTRONEVES L A , et al . A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults [J ] . J Clin Endocrinol Metab , 2013 , 98 ( 8 ): 3238 - 3245 . DOI: 10.1210/jc.2013-1796 http://doi.org/10.1210/jc.2013-1796 https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-1796 https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-1796

DERMODY S , WALLS A , HARLEY E H Jr . Pediatric thyroid cancer: an update from the SEER database 2007-2012 [J ] . Int J Pediatr Otorhinolaryngol , 2016 , 89 : 121 - 126 . DOI: 10.1016/j.ijporl.2016.08.005 http://doi.org/10.1016/j.ijporl.2016.08.005 https://linkinghub.elsevier.com/retrieve/pii/S0165587616302609 https://linkinghub.elsevier.com/retrieve/pii/S0165587616302609

LIU C X , XIAO C , CHEN J J , et al . Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients [J ] . BMC Cancer , 2019 , 19 ( 1 ): 622 . DOI: 10.1186/s12885-019-5835-6 http://doi.org/10.1186/s12885-019-5835-6 https://doi.org/10.1186/s12885-019-5835-6 https://doi.org/10.1186/s12885-019-5835-6

LU Z H , MU Y M , ZHU H Q , et al . Clinical value of using ultrasound to assess calcification patterns in thyroid nodules [J ] . World J Surg , 2011 , 35 ( 1 ): 122 - 127 . DOI: 10.1007/s00268-010-0827-3 http://doi.org/10.1007/s00268-010-0827-3 http://link.springer.com/10.1007/s00268-010-0827-3 http://link.springer.com/10.1007/s00268-010-0827-3

POLAT Y D , ÖZTÜRK V S , ERSOZ N , et al . Is thyroid imaging reporting and data system useful as an adult ultrasonographic malignancy risk stratification method ın pediatric thyroid nodules? [J ] . J Med Ultrasound , 2019 , 27 ( 3 ): 141 - 145 .

陈继来 . 未成年人与成年人甲状腺癌超声特征差异性分析 [J ] . 临床军医杂志 , 2018 , 46 ( 2 ): 221 - 223 .

CHEN J L . Analysis on the difference of ultrasonic characteristics between minors and adults with thyroid cancer [J ] . Clin J Med Off , 2018 , 46 ( 2 ): 221 - 223 .

AL NOFAL A , GIONFRIDDO M R , JAVED A , et al . Accuracy of thyroid nodule sonography for the detection of thyroid cancer in children: systematic review and meta-analysis [J ] . Clin Endocrinol (Oxf) , 2016 , 84 ( 3 ): 423 - 430 . DOI: 10.1111/cen.12786 http://doi.org/10.1111/cen.12786 https://onlinelibrary.wiley.com/doi/10.1111/cen.12786 https://onlinelibrary.wiley.com/doi/10.1111/cen.12786

付鹏 , 陈文 , 崔立刚 , 等 . 不同纵横比算法对预测甲状腺结节良恶性风险的价值 [J ] . 中国医学科学院学报 , 2019 , 41 ( 5 ): 663 - 666 .

FU P , CHEN W , CUI L G , et al . Values of longitudinal and transverse plane ratios in predicting the risk of malignant thyroid nodules [J ] . Acta Acad Med Sin , 2019 , 41 ( 5 ): 663 - 666 .

席雪华 . 甲状腺结节超声多模态成像价值研究 [D ] . 北京 : 北京协和医学院 , 2019 .

XI X H . Evaluated the value of ultrasonographic multimodality diagnostic model of thyroid nodules [D ] . Beijing : Peking Union Medical College , 2019 .

LIM-DUNHAM J E , ERDEM TOSLAK I , ALSABBAN K , et al . Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association management guidelines for children with thyroid nodules and differentiated thyroid cancer [J ] . Pediatr Radiol , 2017 , 47 ( 4 ): 429 - 436 . DOI: 10.1007/s00247-017-3780-6 http://doi.org/10.1007/s00247-017-3780-6 http://link.springer.com/10.1007/s00247-017-3780-6 http://link.springer.com/10.1007/s00247-017-3780-6

PARK C S , KIM S H , JUNG S L , et al . Observer variability in the sonographic evaluation of thyroid nodules [J ] . J Clin Ultrasound , 2010 , 38 ( 6 ): 287 - 293 .

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