Diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy according to nodule size: a comparison with five society guidelines

Ultrasonography

Wooyul Paik¹  Suh Young Kim¹  Hye Yun Gwon¹  Dong Gyu Na¹  Roh-Eul Yoo²  Jaehyung Cha³ 

[1] Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea;Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea;Medical Science Research Center, Korea University College of Medicine, Seoul, Korea;

关键词: thyroid nodule;    thyroid neoplasms;    ultrasonography;    diagnosis;   

DOI  :  10.14366/usg.20148

来源: DOAJ

【 摘 要 】

Purpose The aim of this study was to evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) compared with five society risk stratification systems (RSSs) according to nodule size. Methods In total, 3,826 consecutive thyroid nodules (≥1 cm) with final diagnoses in 3,088 patients were classified according to five RSSs. The K-TIRADS was modified by raising the biopsy size threshold for low-suspicion nodules and subcategorizing intermediate-suspicion nodules. We assessed the performance of the RSSs as triage tests and their diagnostic accuracy according to nodule size (with a threshold of 2 cm). Results Of all nodules, 3,277 (85.7%) were benign and 549 (14.3%) were malignant. In small thyroid nodules (≤2 cm), the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) had the highest reduction rate of unnecessary biopsies (76.3%) and the lowest sensitivity (76.1%). The modified K-TIRADS had the second highest reduction rate of unnecessary biopsies (67.6%) and sensitivity (86.6%). The modified K-TIRADS and ACR TI-RADS had the highest diagnostic odds ratios (P=0.165) and the highest areas under the curve (P=0.315). In large nodules (>2 cm), the sensitivity of the ACR TI-RADS for malignancy was significantly lower (88.8%) than the sensitivities of the modified K-TIRADS and other RSSs, which were very high (98.7%-99.3%) (P<0.001). Conclusion The modified K-TIRADS allows a large proportion of unnecessary biopsies to be avoided, while maintaining high sensitivity and diagnostic accuracy for small malignant tumors and very high sensitivity for large malignant tumors.

【 授权许可】

Unknown