目的

分析甲状腺髓样癌（MTC）超声诊断质量情况，探讨提高超声诊断MTC准确性的措施。

方法

总结2019年1月至2022年12月北京协和医院经病理诊断的81例MTC患者的术前资料，分析超声检查存图、报告描述、诊断符合情况和分类指南应用率。应用美国甲状腺协会（ATA）指南、美国放射学会甲状腺影像报告与数据系统（ACR-TIRADS）及2020年甲状腺结节超声恶性危险分层中国指南（C-TIRADS）对81例MTC声像图进行回顾性评估。由2名医师应用上述3种指南对甲状腺结节重新进行风险分层或分类。采用χ²检验比较初、中级职称组（35例）与高级职称组（46例）、甲状腺专业组（27例）与非甲状腺专业组（54例）超声存图完整率、报告描述完整率、超声诊断符合率和指南应用率的组间差异，比较应用指南组与未应用指南组原始超声报告诊断符合率的差异，比较原始超声报告诊断与应用ATA、ACR-TIRADS及C-TIRADS分类诊断准确性的差异。

结果

MTC的超声存图完整率为88.9%（72/81）、报告描述完整率为92.6%（75/81）、超声诊断符合率为87.7%（71/81）、指南应用率为54.3%（44/81）。初、中级职称组与高级职称组、甲状腺专业组与非甲状腺专业组医师的超声存图完整率、报告描述完整率、诊断符合率、指南应用率比较，差异均无统计学意义（P均＞0.05）。应用指南组和未应用指南组的原始超声报告诊断符合率分别为100%（44/44）和73.0%（27/37），差异具有统计学意义（χ²=11.184，P＜0.001）。重新应用ATA、ACR-TIRADS及C-TIRADS对MTC的诊断符合率高于原始超声报告诊断符合率（97.5%、97.5%、97.5% vs 87.7%），差异具有统计学意义（χ²=7.551，P=0.006）。

结论

MTC的术前原始超声报告诊断符合率较高，但低于应用ATA、ACR-TIRADS及C-TIRADS的诊断符合率。超声医师应熟悉MTC的声像图特征，应用甲状腺结节超声恶性风险分层指南，结合临床及实验室检查结果，以进一步提高超声诊断准确性。

Objective

To analyze the quality of ultrasonic diagnosis of medullary thyroid carcinoma (MTC) and propose measures to improve its accuracy.

Methods

Eighty-one patients with MTC diagnosed by pathology were reviewed at Peking Union Medical College Hospital from January 2019 to December 2022. The sonograms of all the MTCs were retrospectively analyzed using the American Thyroid Association (ATA) risk stratification guidelines, the American College of Radiology thyroid imaging report and data system (ACR-TIRADS), and the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS). Thyroid nodules were re-risk-stratified or classified by 2 physicians using the above three guidelines. The Chi-square test was used to compare the differences in sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, and guideline application rate between physicians with primary or intermediate title (35 cases) and those with senior title (46 cases), and between thyroid professionals (27 cases) and non-thyroid professionals (54 cases), the difference in the coincidence rate of diagnosis made on original ultrasound reports between the group using guidelines and the group not using, and the differences in accuracy of ultrasound report diagnosis, ATA, ACR-TIRADS, and C-TIRADS classification diagnosis.

Results

The sonogram completeness rate for MTC was 88.9% (72/81), the report description completeness rate was 92.6% (75/81), the ultrasound diagnostic coincidence rate was 87.7%(71/81), and the guidelines application rate was 54.3% (44/81). There was no statistically significant difference(P＞0.05) in the sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, or guidelines application rate between the primary and intermediate title group and the senior title group, and between the thyroid professional group and non-professional group. The coincidence rates of diagnosis made on original ultrasound reports in the guidelines application group and non-application group were 100% (44/44) and 73.0% (27/37), respectively, with a statistically significant difference (χ²=11.84,P＜0.001). The coincidence rates of ATA, ACR-TIRADS, and C-TIRADS for MTC were significantly higher than that of diagnosis made on ultrasound reports (97.5%, 97.5%, and 97.5% vs 87.7%, χ²=7.551, P=0.006).

Conclusion

The accuracy of preoperative ultrasound diagnosis for MTC is high, but lower than that of ATA,ACR-TIRADS, and C-TIRADS. Ultrasound physicians should be familiar with sonographic features of MTC,apply ultrasound risk stratification systems, and further improve the quality of ultrasound diagnosis.