Abstract: Background　The malignancy risk stratification system of thyroid nodules can standardize the ultrasound diagnosis of thyroid nodules，which has important significance in guiding the diagnosis and treatment of the disease.However，there is no uniform version currently.Objective　To perform a comparative analysis of the values of three malignancy risk stratification systems of thyroid nodules systems in community hospitals，including Thyroid Imaging Reporting and Data System by Kwak（Kwak TI-RADS），the 2015 American Thyroid Association（ATA）Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer（hereinafter referred to as the ATA Guidelines），and the 2017 Thyroid Imaging Reporting and Data Systems by American College of Radiology（ACR TI-RADS）.Methods　A retrospective analysis was conducted on the two-dimensional ultrasound sonographic features of 986 thyroid nodules in 825 patients examined by Pujiang Community Health Center，Shanghai Minhang District from January 2012 to August 2018.The ultrasound results of thyroid nodules were all confirmed by surgical pathology or thyroid fine-needle aspiration cytology（FNA）．Kwak TI-RADS，ATA Guidelines and ACR TI-RADS were used to classify the ultrasound results，and their ROC curves in differentiating benign and malignant thyroid nodules were evaluated and compared.Results　Of the 986 nodules，479 were malignant and 507 were benign.The AUC of Kwak TI-RADS，ATA Guidelines and ACR TI-RADS were 0.887〔95%CI（0.864，0.909）〕，0.857〔95%CI（0.832，0.882）〕，0.870〔95%CI（0.846，0.895）〕 respectively，and the diagnostic threshold was≥4c，≥high risk，≥5，respectively，indicating that all of them had the value in differentiating benign and malignant thyroid nodules（P<0.05），and Kwak TI-RADS was superior to the latter two ones（Z=4.811，2.513，P<0.05）．Conclusion　All these three systems have high values in differentiating benign and malignant thyroid nodules，but the diagnostic performance of Kwak TI-RADS is slightly better.Moreover，Kwak TI-RADS is simple，clear，and is easy to grasp，so it is suitable for promotion in primary hospitals.

Key words: Thyroid nodule, Thyroid imaging report and data system, Ultrasound screening, Community hospital, ROC curve, Sensitivity, Specificity

摘要： 背景　甲状腺结节恶性分层系统可以规范甲状腺结节超声诊断，对甲状腺结节诊疗具有重要指导意义，但目前仍缺乏统一的版本。目的　比较Kwak版甲状腺影像报告与数据系统（Kwak TI-RADS）、2015年美国甲状腺学会（ATA）《成年人分化型甲状腺癌诊治指南》（以下简称ATA指南）超声风险分层评估及2017年美国放射学会甲状腺影像与数据系统（ACR TI-RADS）在社区医院甲状腺结节诊断中的应用价值。方法　回顾性分析2012年1月—2018年8月上海市闵行区浦江社区卫生服务中心经上海市浦东新区公利医院手术病理及甲状腺细针抽吸细胞学检查（FNA）证实的825例患者（986个甲状腺结节）的二维超声声像图特征，分别用Kwak TI-RADS、ATA指南超声风险分层评估及ACR TI-RADS进行分类，绘制受试者工作特征（ROC）曲线，评价并比较各风险分层系统对甲状腺结节良恶性鉴别的价值。结果　986个甲状腺结节中，病理及FNA确诊恶性结节479个，良性结节507个。Kwak TI-RADS、ATA指南超声风险分层评估及ACR TI-RADS的ROC曲线下面积（AUC）分别是0.887〔95%CI（0.864，0.909）〕、0.857〔95%CI（0.832，0.882）〕、0.870〔95%CI（0.846，0.895）〕，诊断界值分别为≥4c类、≥高危、≥5类。Kwak TI-RADS、ATA指南超声风险分层评估及ACR TI-RADS在甲状腺结节良恶性鉴别中均有诊断价值（P<0.05），且Kwak TI-RADS诊断效能优于ATA指南超声风险分层评估及ACR TI-RADS（Z=4.811、2.513，P<0.05）。结论　Kwak TI-RADS、ATA指南超声风险分层评估及ACR TI-RADS在甲状腺良恶性结节的诊断中均有良好价值，前者诊断效能稍优于后两者，且该版本简单明确、易于掌握，适合在基层医院推广。

关键词: 甲状腺结节, 甲状腺影像报告和数据系统, 超声筛查, 社区医院, ROC曲线, 灵敏度, 特异度