Value Of 2020 Chinese TI-RADS In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective: To compare diagnostic efficacy of 2020 Chinese ultrasound Thyroid Imaging-Reporting and Data System(C-TIRADS),2017 ACR-TIRADS and KwakTIRADS in benign and malignant thyroid nodules.Methods: From January 2018 to October 2020,a total of 513 pathologically proven thyroid nodules(306 benign,207 malignant nodules)were included from the Second Affiliated Hospital of Fujian Medical University and the Third Hospital of Xiamen City.These thyroid nodules were evaluated by ultrasound examination and ultrasonic findings were analyzed retrospectively.With pathology as the golden standard,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of the ACR TI-RADS,C-TI-RADS,and Kwak TI-RADS were calculated.The three classification guidelines were evaluated and measured by ROC curve,and the area under the curve(AUC)were calculated.The diagnostic efficacy of three classification guidelines in benign and malignant thyroid nodules were analyzed and compared.At the same time,all the nodules were divided into large nodules(> 1cm)and small nodules(≤ 1cm).The ROC curves were drawn with pathology as the golden standard,and the sensitivity,specificity,positive predictive value,negative predictive value and AUC of the three classification guidelines were calculated.The diagnostic values of 3 guidelines for 2 different size nodules(>1 cm and ≤1cm)were also compared.Results: In all 513 thyroid nodules,the malignant rates of C-TIRADS classification of2,3,4a,4b,4C and 5 were 0,5.2%,20.8%,72.0%,97.1% and 100% respectively.The malignant rates of ACR-TIRADS classification of 1,2,3,4 and 5 categories were 0,0,7.7%,38.5% and 88.3% respectively.The malignant rates of Kwak-RADS classification of 2,3,4a,4b,4C were 0,6.3%,14.0%,35.9%,84.3% and 100% respectively.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Yorden index of ACR-TIRADS were 0.894,0.944,0.591,0.632,0.951,0.758,and 0.535,respectively.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Yorden index of C-TIRADS were 0.890,0.808,0.701,0.807,0.862,0.840 and 0.509,respectively.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Yorden index of Kwak-TIRADS were 0.897,0.901,0.634,0.670,0.919,0.784,and 0.535,respectively.There was no significant difference among the three guidelines(P > 0.05).The three guidelines have high diagnostic efficacy for >1 cm and ≤1cm nodules.The AUC of large nodules were 0.888 、 0.879 、 0.894.The AUC of small nodules were0.685,0.722 and 0.704.The diagnostic efficacy of large nodules was significantly higher than that of small nodules.Conclusion:1、 C-TIRADS,ACR-TIRADS and Kwak-TIRADS guidelines have high diagnostic efficacy in the diagnosis of benign and malignant thyroid nodules.ACR-TIRADS is the most complicated,but it has higher sensitivity.C-TIRADS is simple and is the highest specific.2、 C-TIRADS guidelines can provide an effective risk stratification method for different sizes of nodules.The diagnostic efficiency of > 1cm nodules is better than that of ≤ 1cm nodules,which is worthy of promotion in hospitals at all levels.