探讨计算机辅助检测和诊断（CAD）系统评估甲状腺结节是否应行细针穿刺活检的临床应用价值。

收集2019年2月至10月哈尔滨医科大学附属第一医院106例欲行细针穿刺活检的甲状腺结节，进行CAD系统、高年资、低年资超声医师评估并按照美国甲状腺学会指南建议穿刺与否，以细针穿刺活检病理结果为“金标准”进行判读。若病理结果为恶性，则判定建议细针穿刺活检有意义；若病理结果为良性，则判定建议细针穿刺活检无意义，分别计算3种方式的敏感度、特异度、阳性预测值、阴性预测值和准确性，比较3种方式的评估效能；按照结节大小将其分为3组：1.0 cm~＜1.5 cm组、1.5 cm~＜2.0 cm组和≥2.0 cm组，研究其对CAD软件评估甲状腺结节穿刺与否这一效能的影响，比较不同组的敏感度、特异度和准确性的差异。3种方式间及各组间差异的比较均采用McNemar检验法。

CAD软件的评估效能与高年资医师相对比，CAD软件的敏感度低，而特异度高，差异均有统计学意义（71.2% vs 84.6%，P=0.039；77.8% vs 61.1%，P=0.049）；CAD软件的评估效能与低年资医师相对比，其敏感度、特异度均高于低年资医师，差异均有统计学意义（71.2% vs 55.8%，P=0.021；77.8% vs 64.8%，P=0.039）；CAD软件的评估准确性与高年资医师相近，但大于低年资医师（74.5% vs 60.4%），差异有统计学意义（P=0.001）。CAD软的评估效能与结节大小有关，当结节最大直径为1.0 cm~＜1.5 cm时，CAD软件的敏感度最高（82.4% vs 40.0% vs 62.5%），差异具有统计学意义（P=0.027）；当结节最大直径≥2.0 cm时，CAD软件具有最高的特异度及准确性（91.7% vs 80.0% vs 53.3%；84.4% vs 81.6% vs 48.0%），差异均具有统计学意义（P=0.023、0.002）。

CAD系统能对甲状腺结节给出合理的细针穿刺活检建议，其评估准确性与高年资医师相近且高于低年资医师，结节大小能影响其评估效能。

To assess the clinical value of computer-aided detection and diagnosis (CAD) system in evaluating the necessity of fine needle aspiration cytology (FNAC) in thyroid nodules.

A total of 106 thyroid nodules were prospectively included in this study. The CAD system, a senior radiologist, and a junior radiologist assessed and determined the necessity of FNAC in thyroid nodules independently. Every nodule was stratified according to the American Thyroid Association guidelines. If the FNAC pathological result was malignancy, the FNAC recommendation was considered meaningful, otherwise the FNAC recommendation was considered meaningless. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the senior radiologist, the junior radiologist, and the CAD system for evaluating thyroid nodules were compared. Thyroid nodules were divided into three groups according to nodule size: 1.05 cm ~ ＜1.5 cm group, 1.5 cm ~ ＜2.0 cm group, and ≥ 2.0 cm group. The effect of nodule size on the efficacy of CAD software in evaluating thyroid nodule puncture was studied. The differences in sensitivity, specificity, and accuracy among different groups were compared. The McNemar test was used for comparing differences in this study.

The sensitivity of the CAD system was lower than that of the senior radiologist (71.2% vs 84.6%, P=0.039), but the specificity was higher than that of the senior radiologist (77.8% vs 61.1%, P=0.049). Both the sensitivity and specificity of the CAD were higher than those of the junior radiologist (71.2% vs 55.8%, P=0.021; 77.8% vs 64.8%, P=0.039). The accuracy of the CAD software was similar to that of the senior radiologist, but higher than that of the junior radiologist (74.5% vs 60.4%, P=0.001). The evaluation efficiency of the CAD system was related to the size of nodules. The sensitivity of the CAD in the 1.0 cm ~ ＜1.5 cm group was the highest. When the maximum diameter of nodules was ≥2.0 cm, the specificity and accuracy of the CAD were the highest (91.7% vs 80.0% vs 53.3%; 84.4% vs 81.6% vs 48.0%); the differences were statistically significant (P=0.023 and 0.002, respectively).

The CAD system can be used to determine the detect the necessity of FNAC for suspicious lesions. There is no significant difference in accuracy of assessme nt between the CAD system and the senior radiologist, while the accuracy of the CAD system is higher than that of the junior radiologist. Nodule size is a potential factor affecting evaluation performance of the CAD system.