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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (05) : 440 -446. doi: 10.3877/cma.j.issn.1672-6448.2022.05.009

浅表器官超声影像学

基于甲状腺成像报告和数据系统分类的计算机辅助诊断系统对甲状腺癌超声诊断的辅助价值
金壮1, 朱亚琼2, 张诗杰3, 宋青2, 罗渝昆2,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心超声科；110016　沈阳，北部战区总医院超声科
    2. 100853　北京，解放军总医院第一医学中心超声科
    3. 100871　北京大学前沿交叉学科研究院
  • 收稿日期:2020-05-21 出版日期:2022-05-01
  • 通信作者: 罗渝昆
  • 基金资助:
    国家自然科学基金(81771834)

Auxiliary value of computer-assisted diagnosis system based on thyroid imaging reporting and data system for ultrasound diagnosis of thyroid cancer

Zhuang Jin1, Yaqiong Zhu2, Shijie Zhang3, Qing Song2, Yukun Luo2,†()   

  1. 1. Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang 110016, China
    2. Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    3. Institute of Frontier Interdisciplinary Disciplines, Peking University, Beijing 100871, China
  • Received:2020-05-21 Published:2022-05-01
  • Corresponding author: Yukun Luo
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引用本文：

金壮, 朱亚琼, 张诗杰, 宋青, 罗渝昆. 基于甲状腺成像报告和数据系统分类的计算机辅助诊断系统对甲状腺癌超声诊断的辅助价值[J]. 中华医学超声杂志（电子版）, 2022, 19(05): 440-446.

Zhuang Jin, Yaqiong Zhu, Shijie Zhang, Qing Song, Yukun Luo. Auxiliary value of computer-assisted diagnosis system based on thyroid imaging reporting and data system for ultrasound diagnosis of thyroid cancer[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(05): 440-446.

目的

探讨基于甲状腺成像报告和数据系统（TI-RADS）分类的计算机辅助诊断（CAD）系统对超声医师诊断甲状腺癌的辅助价值。

方法

收集2018年10月至2019年3月在国内5家医院的400例甲状腺结节超声图像进行多中心回顾性研究。采用由北京大学前沿交叉学科研究院研发的基于TI-RADS分类的CAD系统，超声医师诊断甲状腺癌的诊断模式分为无CAD模式和CAD模式，11名具有不同工作经验的超声医师（低年资超声医师4名，中年资超声医师4名，高年资超声医师3名）在上述2种模式下诊断甲状腺癌。比较2种诊断模式的诊断效能及读片时间：绘制CAD系统和超声医师诊断甲状腺癌的受试者工作特征（ROC）曲线，应用DeLong方法比较2种模式下曲线下面积（AUC）的差异；应用配对t检验比较2种模式的读片时间差异。

结果

在CAD模式下，所有超声医师诊断甲状腺癌的AUC值较无CAD模式有显著提高［0.848（0.837~0.858） vs 0.800（0.788~0.812）］，差异具有统计学意义（P＜0.001）；敏感度从73.8%（95%CI：71.9%~75.6%）提升到82.7%（95%CI：81.0%~84.3%），差异具有统计学意义（χ2=9.870，P＜0.001）；特异度从86.2%（84.7%~87.6%）提升到86.9%（85.4%~88.3%），但差异无统计学意义（χ2=0.021，P=0.379）。进行亚组分析时，在CAD模式下，低年资超声医师和中年资超声医师诊断甲状腺癌的AUC值较无CAD模式有显著提高（0.840 vs 0.740；0.848 vs 0.814），差异具有统计学意义（P＜0.001、=0.001），但高年资超声医师诊断甲状腺癌的AUC值较无CAD模式无明显变化（0.859 vs 0.861，P=0.861）。在CAD模式下，所有超声医师的阅片时间较无CAD模式减少［（20.2±8.2）s vs（22.7±9.6）s］，差异具有统计学意义（t=-23.9，P＜0.001）。

结论

CAD模式有助于低年资超声医师和中年资超声医师对甲状腺癌的诊断，同时缩短了诊断时间。

关键词: 计算机辅助诊断, 甲状腺肿瘤, 超声, 超声医师
Objective

To assess the value of a computer aided diagnosis (CAD) system based on the classification of thyroid imaging reporting and data system (TI-RADS) in the ultrasound diagnosis of thyroid cancer.

Methods

From October 2018 to March 2019, 400 cases of thyroid nodules were collected at five domestic hospitals for a multi-center retrospective study. A CAD system based on the TI-RADS classification developed by Peking University was used. With and without the aid of the CAD system, 11 radiologists with different experiences (4 junior radiologists, 4 intermediate-level radiologists, and 3 senior radiologists) diagnosed thyroid cancer, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) was compared using the DeLong method, the sensitivity and specificity were compared using the paired chi-square test, and the reading time was compared using the paired t test.

Results

With the aid of the CAD system, the average AUC of all radiologists for diagnosing thyroid cancer was significantly higher than that without the aid of the CAD system [0.800 (0.788-0.812) vs 0.848 (0.837-0.858), P＜0.001]; the sensitivity significantly increased from 73.8% (71.9%-75.6%) to 82.7% (81.0%-84.3%, χ2=9.870, P＜0.001), and the specificity increased from 86.2% (84.7%-87.6%) to 86.9% (85.4%-88.3%), but there was no statistical difference (χ2=0.021, P=0.379). When performing subgroup analysis, with the aid of the CAD system, the AUC values of junior and intermediate-level radiologists for diagnosing thyroid cancer were significantly higher than those without the aid of the CAD system (junior radiologists: 0.740 vs 0.840, P＜0.001; intermediate-level radiologists: 0.814 vs 0.848, P=0.001), but the AUC value of senior radiologists was not significantly different from that without the aid of the CAD system (0.861 vs 0.859, P=0.861). With the aid of the CAD system, the reading time of all radiologists was significantly shortened compared with that without the aid of the CAD system (22.7±9.6 vs 20.2±8.2; P＜0.001).

Conclusion

The CAD system is helpful in the diagnosis of thyroid cancer by both junior radiologists and intermediate-level radiologists, and can reduce the time to achieve diagnosis.

Key words: Computer-assisted diagnosis, Thyroid cancer, Ultrasound, Radiologists
表1 甲状腺结节的超声检查特征［例（%）］
特征 恶性结节（n=197） 良性结节（n=203） χ2值 P值
成分 80.3 ＜0.001

囊性或囊性为主

 0（0） 31（15.3）

海绵状

 1（0.5） 14（6.9）

囊实混合性

 3（1.5） 32（15.8）

实性或实性为主

 193（98.0） 126（62.1）
回声 175.1 ＜0.001

无回声

 0（0） 34（16.7）

高或等回声

 12（6.1） 108（53.2）

低回声

 155（78.7） 56（27.6）

极低回声

 30（15.2） 5（2.5）
形状 107.2 ＜0.001

纵横比≥1

 109（55.3） 15（7.4）

纵横比＜1

 88（44.7） 188（92.6）
边界 197.8 ＜0.001

光滑

 34（17.3） 177（87.2）

模糊

 125（63.5） 24（11.8）

不规则或分叶状

 29（14.7） 2（1.0）

向包膜外侵犯

 9（4.6） 0（0）
钙化 10.8 0.028

无钙化

 64（32.5） 179（88.2）

粗大钙化

 2（1.0） 2（1.0）

周围钙化

 10（5.1） 5（2.5）

微钙化

 117（59.4） 15（7.4）

混合钙化

 4（2.0） 2（1.0）
图1 计算机辅助诊断系统诊断甲状腺癌的受试者操作特征曲线
图2 所有超声医师在无CAD模式下和CAD模式下诊断甲状腺癌的受试者操作特征曲线注：CAD为计算机辅助诊断
图3 低年资超声医师在无CAD模式下和CAD模式下诊断甲状腺癌的受试者操作特征曲线注：CAD为计算机辅助诊断
图4 中年资超声医师在无CAD模式下和CAD模式下诊断甲状腺癌的受试者操作特征曲线注：CAD为计算机辅助诊断
图5 高年资超声医师在无CAD模式下和CAD模式下诊断甲状腺癌的受试者操作特征曲线注：CAD为计算机辅助诊断
表2 在2种诊断模式下超声医师的阅片时间比较（s，
xˉ
±s）
诊断模式 低年资超声医师组 中年资超声医师组 高年资超声医师组 所有超声医师组
无CAD 25.1±10.1 23.4±9.4 18.7±7.5 22.7±9.6
CAD 21.0±7.7 18.1±6.9 16.9±6.8 20.2±8.2
差值（95%CI） -4.1（-4.7~-3.4） -5.2（-5.8~-4.7） -1.8（-2.4~-1.2） -2.5（-2.9~-2.2）
t值 -14.5 -19.2 -6.5 -23.9
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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