目的 基于超声特征与超声影像组学构建联合诊断模型，评估其对Bethesda Ⅲ类结节良恶性再评价的诊断效能。 方法 回顾性收集2019年1月至2024年9月经细针穿刺抽吸活检术（FNAB）后被归为Bethesda Ⅲ类结节，且获得手术病理的甲状腺结节患者共442例。按7∶3的比例随机分为训练集和测试集。收集相关临床特征，在病灶最可疑切面勾勒感兴趣区（ROI），提取超声影像组学特征，并筛选出关键影像组学特征，计算影像组学分数（Rad-score）。构建超声诊断模型、影像组学诊断模型和联合诊断模型，分别采用受试者工作特征曲线（ROC）下面积（AUC）和临床决策曲线分析（DCA）评估各模型的诊断效能及临床应用价值。 结果 单因素分析和多因素logistic回归分析结果显示，微钙化、边缘不规则及Rad-score是Bethesda Ⅲ类结节恶性转化的独立危险因素。测试集中的超声诊断模型、影像组学诊断模型和联合诊断模型的AUC分别为0.76、0.71和0.81。联合诊断模型的校准曲线表明预测值与实际值之间具有良好的一致性。测试集的DCA显示联合诊断模型具有较高的临床实用价值。 结论 基于超声特征和超声影像组学构建的联合诊断模型对Bethesda Ⅲ类结节的恶性风险具有更高的预测价值。

Objective To construct a combined model integrating ultrasonic features and radiomics derived from ultrasound images， and to evaluate its diagnostic performance in re - assessing the benign or malignant nature of Bethesda Ⅲ nodules. Methods A retrospective study was carried out on 442 patients with thyroid nodules classified as Bethesda Ⅲ after fine-needle aspiration biopsy （FNAB） between January 2019 and September 2024. All patients had undergone surgical pathology. The patients were randomly allocated into a training set and a testing set at a ratio of 7∶3. Relevant clinical characteristics were gathered， and regions of interest （ROI） were outlined on the most suspicious slice of the lesion prior to biopsy. Ultrasound radiomics features were extracted， key radiomics features were selected， and radiomics scores （Rad-score） were computed. The ultrasound model， radiomics model， and combined model were constructed. Subsequently， the diagnostic efficacy and clinical application value of each model were evaluated using the area under the receiver operating characteristic curve （AUC） and decision curve analysis （DCA）. Results Univariate analysis and multivariate logistic regression analysis findings indicated that microcalcification， irregular margin， and Rad-score were independent risk factors for the malignant transformation of Bethesda Ⅲ nodules. In the testing set， the AUC values of the ultrasound model， radiomics model， and combined model were 0.76， 0.71， and 0.81， respectively. The calibration curve of the combined model revealed a good consistency between the predicted values and the actual outcomes. The DCA of the testing set demonstrated that the combined model exhibited high clinical utility. Conclusion The combined model， established based on ultrasonic features and ultrasound radiomics， provides a higher predictive value for evaluating the malignancy risk of Bethesda Ⅲ nodules.