Comparison Of Application Value Of American College Of Radiology (ACR) Guidelines And American Thyroid Association (ATA) Management Guidelines In Risk Stratification Assessment Of Thyroid Nodule

Objectives:To compare the American College of Radiology(ACR)thyroid imaging reporting and data system(TIR-ADS)and American Thyroid Association(ATA)management guidelines for thyroid nodules with regard to diagnostic performance and effectiveness at reducing the number of fine-needle aspiration(FNA)biopsies and to improve the diagnostic accuracy,sensitivity,specificity of thyroid nodules and reduce unnecessary FNA biopsy.Materials and methods:In the present study,2108 patients with thyroid nodules(2314 nodules in total)underwent thyroid ultrasonography and had clear pathological results in our hospital from April 2016 to June 2018.The sonographic characteristics of 2314 nodules were analyzed retrospectively,and the nodules were classified according to the classification criteria of the two guidelines for risk stratification.The diagnostic performance of the two guidelines for thyroid nodules was analyzed with the pathological results as the gold standard.Results:The sensitivity of the ATA guidelines was 91.3%,and the negative predictive value(NPV)was 75.3%,which were higher than the ACR TI-RADS guidelines of 80.8% and 69.1%,respectively.There were statistical differences(P<0.05).The specificity of the ACR TI-RADS guidelines was 61.2%,the positive predictive value(PPV)was 74.8%,and the accuracy was 72.7%,which were higher than the 38.1%,67.7%,and 69.3% of the ATA guidelines,respectively.There were statistical differences(P<0.05).The unnecessary FNA biopsy of the ACR TI-RADS guidelines was 23.3%,which was significantly lower than the 34.4% of the ATA guidelines,and the difference was statistically significant(P<0.05).For subgroups less than 1 cm in diameter,the sensitivity of the ATA guidelines was 92.5%,and the negative predictive value(NPV)was 76.9%,which were higher than the ACR TI-RADS guidelines of 75.8% and 64.3%,respectively.There were statistical differences(P<0.05).The specificity of the ACR TI-RADS guidelines was 62.3%,and the positive predictive value(PPV)was 74.2%,which was higher than the ATA guidelines of 35.6% and 67.3%,respectively.There were statistical differences(P<0.05).The accuracy of the ACR TI-RADS guidelines was 70.2%,which was slightly higher than the 69.1% of the ATA guidelines,but the difference was not statistically significant(P> 0.05).Conclusions:(1)In terms of thyroid nodule diagnostic performances,the ACR TI-RADS guidelines have higher specificity and accuracy,and the ATA guidelines have higher sensitivity.(2)In terms of reducing the number of FNA biopsies,the ACR TIRADS guidelines were superior to the ATA guidelines.(3)In subgroup nodules less than 1cm,the ACR TI-RADS guidelines have higher specificity,and the ATA guidelines have higher sensitivity.