Background:Thyroid nodules are common yet remain a diagnostic challenge. While ultrasound and Thyroid Imaging Reporting and Data Systems (TIRADS) are accepted as standard, the use of thyroid scintigraphy in euthyroid patients is debated. The European Association of Nuclear Medicine advocates it, whereas the American Thyroid Association and European Thyroid Association do not. However, it has not been evaluated whether scintigraphy adds value to TIRADS in a multimodal approach. Our study addresses this gap by assessing the impact of integrated pertechnetate scintigraphy on TIRADS accuracy.Methods:The diagnostic performance of ACR-TIRADS, EU-TIRADS, pertechnetate scintigraphy, and multimodal models were retrospectively analyzed for 322 nodules (231 benign, 91 malignant) in 208 euthyroid patients with histopathology as a reference. Generalized estimating equations were used for statistical analysis.Results:On scintigraphy, 210 nodules were hypofunctional, 99 isofunctional, and 13 hyperfunctional. The AUC for thyroid scintigraphy, ACR-TIRADS, and EU-TIRADS were 0.6 (95% CI: 0.55–0.66), 0.83 (95% CI: 0.78–0.88), and 0.78 (95% CI: 0.72–0.83). Integrating scintigraphy with ACR-TIRADS and EU-TIRADS slightly increased diagnostic accuracy (AUC 0.86 vs. 0.83,p= 0.039 and AUC 0.80 vs. 0.78,p= 0.008) and adjusted the malignancy probability for intermediate risk TIRADS categories, with iso- or hyperfunctioning nodules in ACR-TIRADS-TR4 or EU-TIRADS-4 showing comparable malignancy probabilities as hypofunctioning nodules in TR3 or EU-TIRADS-3, respectively.Conclusions:Integrating thyroid scintigraphy with ACR- or EU-TIRADS moderately improves diagnostic performance, potentially benefiting management, especially in complex cases like multinodular goiter or indeterminate FNA. Further research is warranted to validate these findings and explore their clinical implications.
背景：甲状腺结节虽常见，但其诊断仍具挑战性。尽管超声和甲状腺影像报告与数据系统（TIRADS）已被视为标准方法，但甲状腺功能正常患者是否应使用甲状腺闪烁显像仍存争议。欧洲核医学协会支持其应用，而美国甲状腺协会和欧洲甲状腺协会则持不同意见。然而，在多模态诊断策略中，闪烁显像能否为TIRADS增加价值尚未得到充分评估。本研究通过评估整合高锝酸盐闪烁显像对TIRADS诊断准确性的影响，填补了这一空白。 方法：回顾性分析208例甲状腺功能正常患者的322个结节（231个良性，91个恶性），以组织病理学结果为金标准，评估ACR-TIRADS、EU-TIRADS、高锝酸盐闪烁显像及多模态模型的诊断效能。采用广义估计方程进行统计分析。 结果：闪烁显像显示210个结节为低功能，99个为等功能，13个为高功能。甲状腺闪烁显像、ACR-TIRADS和EU-TIRADS的曲线下面积（AUC）分别为0.6（95% CI: 0.55–0.66）、0.83（95% CI: 0.78–0.88）和0.78（95% CI: 0.72–0.83）。将闪烁显像与ACR-TIRADS和EU-TIRADS整合后，诊断准确性略有提升（AUC从0.83升至0.86，p=0.039；AUC从0.78升至0.80，p=0.008），并调整了中危TIRADS类别的恶性概率。具体而言，ACR-TIRADS-TR4或EU-TIRADS-4类别中的等或高功能结节，其恶性概率分别与TR3或EU-TIRADS-3类别中的低功能结节相当。 结论：将甲状腺闪烁显像与ACR-TIRADS或EU-TIRADS整合可适度提升诊断性能，可能有助于临床管理，特别是在多结节性甲状腺肿或细针穿刺结果不确定等复杂病例中。需进一步研究以验证这些发现并探讨其临床意义。
肿瘤(癌症)患者之家