Comparison Of The Diagnostic Performance Of 2015 American Thyroid Association Management Guidelines,2017 American College Of Radiology And Kwak Thyroid Imaging Reporting And Data System

Objective: To compare the diagnostic performance of thyroid imaging reporting and data system(TI-RADS)on thyroid nodules published by American College of Radiology(ACR TI-RADS)at 2017,Kwak(Kwak TI-RADS)at 2011 and 2015 American Thyroid Association(ATA)management guidelines.Mothed: Preoperative ultrasound images and reports of 457 thyroid nodules(504 nodules)were review and analyzed.Nodules were classified according to ATA guidelines and two TI-RADS criteria,and receiver operating characteristic curves of the classifications were constructed with pathological results as the gold standard.To analyze the diagnostic value of ATA guideline and two TI-RADS for thyroid nodules and compare their diagnostic performance.Result:For the 504 thyroid nodules,malignant rate for benign,very low suspicion,low suspicion,intermediate suspicion,and high suspicion by ATA guidelines was 0,0,3.1%,8.7%,74.9%,malignant rate for TR1-TR5 category patients classified by ACR TI-RADS was 0,0,2.7%,25.3%,76.4%,respectively;and that for 2,3,4a,4b,4c,5 category classified by Kwak TI-RADS was 0,0,10.1%,13.5%,72.5%,83.3%,respectively.Accuracy,susceptibility,specificity,positive predictive value(PPV),negative predictive value(NPV)and area under curve(AUC)of benign and malignant thyroid nodules diagnosed by ATA guidelines were 77.0%,98.1%,61.7%,65.1%,97.8%,0.8697,respectively.Accuracy,susceptibility,specificity,positive predictive value(PPV),negative predictive value(NPV)and area under curve(AUC)of benign and malignant thyroid nodules diagnosed by ACR TI-RADS were 77.0%,96.2%,63.0%,65.4%,95.8%,0.8839,respectively.Accuracy,susceptibility,specificity,positive predictive value(PPV),negative predictive value(NPV)and area under curve(AUC)of benign and malignant thyroid nodules diagnosed by Kwak TI-RADS were 77.0%,96.2%,63.0%,65.4%,95.8%,0.8839,respectively.No statistical difference in accuracy,susceptibility,specificity,PPV,NPV or AUC was found in the three groups(P>0.05).17 nodules could not be classified according to ATA criteria,3.4% of total thyroid nodules(17/504),in which 10 nodules were benign and 7 nodules were malignant.The malignant rate of ‘unclassified' nodules was 41.2%(7/17).Conclusion:Both ATA guidelines and two TI-RADS performed quite well in diagnosing benign and malignant thyroid nodules,and all of them can obtain high sensitivity and negative predictive value.‘Unclassified' nodules by ATA guidelines was at relatively high risk of malignancy.