Comparison Of The Diagnostic Value Of The C-TIRADS Guidelines With The ACR-TIRADS Guidelines In The Risk Stratification Of Thyroid Nodules For Malignancy

Objectives:To compare the diagnostic value and fine needle aspiration biopsy efficacy of the 2020 Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)with the ACR-TIRADS guidelines issued by the American College of Radiology in 2017 for thyroid nodules,thereby reducing the burden of missed diagnoses,misdiagnoses,and unnecessary biopsies for patients.Methods:Patients who were diagnosed with thyroid nodules with definite pathological findings by ultrasonography performed at the Sino-Japanese Friendship Hospital of Jilin University from October 2019 to November 2021 were selected for this study,and a total of 2,064 nodules from 1,627 patients were included.Two senior physicians independently retrospectively analyzed the ultrasound image characteristics of all nodules and classified according to two guidelines respectively.The diagnostic efficacy and the rates of unnecessary biopsies were compared between the C-TIRADS and ACR-TIRADS stratification systems with pathological findings as the "gold standard".Results : There was a high agreement between the two guidelines in the assessment of benign and malignant thyroid nodules(Kappa=0.86>0.75,P<0.001).The overall accuracy rate was 89.49% for the C-TIRADS guideline and 88.23% for the ACR-TIRADS guideline,and the difference was not statistically significant(P>0.05).Among the 1049 nodules with a diameter of <1cm,the specificity of the C-TIRADS guideline was 79.04% and the positive predictive value was 90.44%,which was higher than the 67.66% and 86.28% of the ACR-TIRDAS guideline,with a statistically significant difference(P<0.05).Among the 1015 nodules ≥1cm in diameter,the diagnostic efficacy of the C-TIRADS guideline was comparable to that of the ACR-TIRADS guideline.The rate of unnecessary biopsy was higher in the C-TIRADS guideline(24.9%)than in the ACR-TIRADS guideline(20.2%),and the difference was statistically significant(P<0.05).The rate of missed nodules was slightly higher in the ACR-TIRADS guideline(59.7%)than in the C-TIRADS guideline(58.1%),and the difference was not statistically significant(P>0.05).Conclusions:(1)In terms of the diagnostic efficacy of thyroid nodules,the two guidelines had high consistency in the diagnostic results of thyroid nodules,and both had higher sensitivity,but the C-TIRADS guideline had higher specificity and positive predictive value,and the ACR-TIRADS guideline had better overall diagnostic efficacy.(2)In the subgroup of nodules <1cm in diameter,the specificity as well as the positive predictive value of C-TIRADS guideline were higher than those of the ACR-TIRADS guideline;in the subgroup of nodules ≥1cm in diameter,the diagnostic efficacy of the two guidelines was not significantly different.(3)Compared with the ACR-TIRADS guideline,the C-TIRADS guideline can relatively reduce unnecessary fine needle aspiration biopsies.