Comparison Of The Application Value Of Kwak,American College Of Radiology And Chinese Thyroid Imaging Reporting And Data System In Bethesda Ⅲ Thyroid Nodules

Objective:To compare the application value of Thyroid Imaging Report and Data System developed by Kwak(Kwak TI-RADS)in 2011,the Thyroid Imaging Report and Data System issued by the American College of Radiology(ACR TI-RADS)in 2017 and the2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules(C-TIRADS)for BethesdaⅢ thyroid nodules in US-FNAC,in order to guide clinical management of the patients.Methods:The clinical and ultrasound data of 180 thyroid nodules in 175 patients who underwent thyroid ultrasound and US-FNAC and cytology results of BethesdaⅢand surgery in Affiliated People’s Hospital of Shanxi Medical University from January 2018to June 2020 were retrospectively analyzed.Each thyroid nodule was classified by 2011Kwak TI-RADS,2017 ACR TI-RADS and 2020 C-TIRADS respectively.They were divided into benign group and malignant group according to pathological diagnosis.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area under the curve(AUC)of Kwak TI-RADS,ACR TI-RADS and C-TIRADS for BethesdaⅢ thyroid nodules were calculated by ROC curve.Compare the diagnostic performance of various Thyroid Imaging Report and Data System for BethesdaⅢ thyroid nodules.The nodules were further divided into more than 1cm group and less than or equal to 1cm group according to the maximum diameter of the nodules,and the diagnostic performance of each Thyroid Imaging Report and Data System for BethesdaⅢ thyroid nodules of different sizes was analyzed and compared.Results:Of the 180 thyroid nodules,66 cases were benign nodules and 114 cases were malignant nodules.With the increase of Kwak TI-RADS,ACR TI-RADS and C-TIRADS classification,the malignant risk of nodules increases significantly(r_s=0.574、0.653、0.519,respectively,P<0.05);With Kwak TI-RADS 4c、ACR TI-RADS 5、C-TIRADS 4C as the cut-off point,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the diagnosis of BethesdaⅢ thyroid nodules are respectively(1)Kwak TI-RADS:82.5%,69.7%,77.8%,82.5%,69.7%,0.814;(2)ACR TI-RADS:83.3%,80.3%,82.2%,88.0%,73.6%,0.841;(3)C-TIRADS:63.2%,83.3%,70.6%,86.7%,56.7%,0.792.Compared with Kwak TI-RADS and C-TIRADS,ACR TI-RADS has higher sensitivity,accuracy,positive predictive value and negative predictive value,and the difference in sensitivity and accuracy is statistically significant(P<0.05),the difference between positive predictive value and negative predictive value is not statistically significant(P>0.05);C-TIRADS has higher specificity,but the difference is not statistically significant(P>0.05).The area under the curve of ACR TI-RADS are the largest in>1cm group and≤1cm group,which are 0.846 and 0.771,respectively.Conclusion:1.The malignant risk in BethesdaⅢ thyroid nodules increases with the classification increase of Kwak TI-RADS,ACR TI-RADS and C-TIRADS respectively.2.Different Thyroid Imaging Report and Data System have certain diagnostic performance for BethesdaⅢ thyroid nodules,and ACR TI-RADS has higher sensitivity and accuracy.3.The diagnostic performance of ACR TI-RADS for BethesdaⅢ thyroid nodules>1cm is better than that of BethesdaⅢ thyroid nodules≤1cm.4.For US-FNAC cytology results of BethesdaⅢ thyroid nodules,the preoperative ultrasound classification results can be used as the basis for choosing the following diagnosis and treatment plan.