Abstract
Introduction: To compare the efficacy of four different ultrasound-based risk-stratification systems in assessing the malignancy risk of thyroid nodules in the Chinese population.Methods: We retrospectively reviewed the digital ultrasound images of 1,568 patients (1,612 thyroid nodules) who underwent surgery in our hospital between January 2012 and December 2017. All thyroid nodules were pathologically identified as malignant or benign. We evaluated the following ultrasound characteristics: size, location, composition, echogenicity, shape, margins, calcification or echogenic foci, and extrathyroidal extension. Each nodule was categorized using four risk-stratification systems: the American Thyroid Association (ATA) classification, the Thyroid Imaging, Reporting, and Data System (TIRADS) of the American College of Radiology (ACR-TIRADS), the European Thyroid Association TIRADS (EU-TIRADS), and the TIRADS developed by Kwak et al. (Kwak-TIRADS). The diagnostic performance of each risk-stratification system relative to the pathological results was analyzed. We used receiver operating characteristic curves to identify cutoff values that yielded optimal sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC).Results: Of the 1,612 nodules, 839 (52.0%) were benign, and 773 (48.0%) were malignant. The AUCs of the ACR-TIRADS, EU-TIRADS, Kwak-TIRADS, and ATA classification were 0.879, 0.872, 0.896, and 0.869, respectively. The Kwak-TIRADS had the best SEN, NPV, ACC, and AUC, while the ACR-TIRADS had the best SPE and PPV.Conclusion: All four risk-stratification systems had good diagnostic performances (AUCs > 86%). Considering its high SEN, NPV, ACC, and AUC, we believe that the Kwak-TIRADS may be the more effective risk-stratification system in the Chinese population.
Highlights
To compare the efficacy of four different ultrasound-based risk-stratification systems in assessing the malignancy risk of thyroid nodules in the Chinese population
The purpose of this study was to compare the four risk-stratification systems used in our research center, namely, the American Thyroid Association (ATA) classification, the ACR-TIRADS, the EU-TIRADS, and the Kwak-TIRADS, in terms of their efficacy in determining the malignancy risk of thyroid nodules
Surgery was considered to be indicated for nodules that showed at least two ultrasound features that were highly suggestive of malignancy and for nodules that appeared to be benign but were associated with clinical symptoms
Summary
To compare the efficacy of four different ultrasound-based risk-stratification systems in assessing the malignancy risk of thyroid nodules in the Chinese population. The risk-stratification systems commonly used to classify thyroid nodules are [1] the American Thyroid Association (ATA) classification, [2] the Thyroid Imaging, Reporting, and Data System (TIRADS) developed by the American College of Radiology (the ACR-TIRADS), [3] the TIRADS published by the European Thyroid Association (the EU-TIRADS), [4] the TIRADS developed by Kwak et al (the Kwak-TIRADS), and [5] the British Thyroid Association classification. These five risk-stratification systems are based on a comprehensive analysis of multiple ultrasonographic features, and enable the stratification of the malignancy risk of thyroid nodules and provide a basis for determining the necessity of US-FNA
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