A Comparative Study On The Risk Assessment Of Thyroid Nodule Ultrasonic Malignancy By Different Evaluation

ObjectiveIn the Chinese population,using the TI-RADS published by National Health Commission of the People’s Republic of China(NHC)S,TI-RADS published by American College of Radiology(ACR)and Management Guidelines for Adult Patients with Thyroid Nodules American published by Thyroid Association(ATA)to evaluate the benign and malignant effects of ultrasound on thyroid nodule,and to compare the diagnostic efficacy of these three methods.Materials and MethodsFrom August to December 2018,a total of 174 thyroid nodules in 132 patients who received thyroidectomy and obtained the final pathological results at Shandong Provincial Qianfoshan Hospital were included.To evaluate the grayscale ultrasonographic features of nodules and classify them with these three evaluation systems.The pathological results were taken as the gold standard for evaluation,and then the receiver operating characteristic(ROC)curves of these three classifications for the diagnosis of thyroid nodules were made to obtain the optimal cutoff points respectively.The sensitivity,specificity,PPV,NPV and accuracy of these three evaluation systems were calculated and compared.Kappa test was used to analyze the consistency of any two of the three standards.Multivariate Logistic regression was used to analyze the malignant risk factors of ultrasonic signs of thyroid nodules in three groups according to the maximum diameter≤1cm,>lcm,≤2cm and>2cm.ResultsOf all the nodules,86(49.7%)were benign,whereas 87(50.3%)were malignant.AUC of the ROC of NHC TI-RADS,ACR TI-RADS and ATA guidelines were 0.913,0.915 and 0.881 respectively.Best cutoff point for diagnosing malignant by these three evaluation categories were≥4c,≥5 and≥highly suspicious malignancy,respectively.At that point,the sensitivity,specificity,PPV,NPV and accuracy for NHC TI-RADS were 87.4%,88.4%,88.4%,87.4%and 87.9%,respectively;for ACR TI-RADS were 83.9%,89.5%,89.0%,84.6%,86.7%,respectively;for ATA guidelines were 87.4%,83.7%,84.4%,86.7%,85.5%,respectively.Pairwise comparison of the three evaluation systems showed there were no statistically significant differences in the above indicators(P>0.05).Kappa=0.84(P<0.05)between NHC and ACR TI-RADS,0.87(P<0.05)between NHC TI-RADS and ATA guidelines,and the Kappa between ACR TI-RADS and ATA guidelines was 0.80(P<0.05),which showing good consistency among the three.For the group ≤cm,the risk of malignancy was higher in the group with taller-than-wide than in the group with wider-than-tall(OR=12.07).For>lcm and ≤2cm group,those who were irregular or lobulated(OR=48.75),taller-than-wide(OR=21.00)or microcalcification in nodules(OR=14.88)had a higher risk of malignancy.For thyroid nodules of>2cm,microcalcification(OR=51.33),irregular or lobulated morphology(OR=18.50),or extra-thyroidal extension(OR=27.75)were associated with a higher risk of malignancy.ConclusionThe diagnostic efficiency of NHC TI-RADS and ACR TI-RADS for thyroid nodules is high and ATA guidelines is medium.The three evaluation systems have good consistency in thyroid nodule evaluation.Different ultrasound signs have different diagnostic efficacy for thyroid nodules of different sizes,nodes≤1cm should pay attention to aspect ratio relationship,while nodes>1cm should pay attention to the characteristics of microcalcification,irregularity or lobulated.