A Multicenter Study Of ACR-TIRADS And C-TIRADS Stratification Combined With SWE Imaging Technology In Thyroid Nodules

Objective To discuss the efficacy of the 2017 Thyroid Imaging Reporting and Data System proposed by American College of Radiology(ACR-TIRADS),the 2020 Chinese guidelines for ultrasound malignant risk stratification of thyroid nodules(C-TIRADS),and shear wave elastography(SWE)for differential diagnosis of the benign and malignant thyroid nodules.To Compare and validate the diagnostic value of ACR-TIRADS and C-TIRADS stratification respectively in combination with SWE in thyroid nodules.Methods The conventional ultrasound image characteristics of 942 thyroid nodules and the maximum parameter value of shear wave velocity(E max)of SWE were retrospectively analyzed,and senior ultrasonographers trained by ACR-TIRADS and C-TIRADS guidelines assigned score value according to the ultrasound characteristics of each nodule by ACR-TIRADS and C-TIRADS stratification,respectively,after accumulating the total score and classified.The results were recorded into different groups.The operating characteristic curve(ROC)was plotted and the diagnostic efficacy of ACR-TIRADS,C-TIRADS stratification and SWE independent diagnosis of thyroid nodules were analyzed and compared by using the pathological results of fine needle aspiration(FNA)or surgery as the "gold standard".According to the best cut-off value of SWE,the thyroid nodes in ACR-TIRADS stratification group were readjusted for grading and compared the diagnostic efficacy of ACR-TIRADS stratification and the combination with SWE.According to the best cut-off value of SWE,the thyroid nodes in C-TIRADS stratification group were readjusted for grading and compared the diagnostic efficacy of C-TIRADS stratification and the combination with SWE.The value of SWE and the combination with C-TIRADS stratification for the differentiation of benign and malignant thyroid micro-nodules(maximum diameter ≤10 mm)were validated.The comparison of the diagnostic efficacy between two combined diagnostic methods was visualized,which ACR-TIRADS and C-TIRADS stratification respectively in combination with SWE.Results(1)The difference in the area under curve(AUC)of the thyroid nodules diagnosed by SWE(0.859)was statistically significant(P < 0.01),which was higher than the AUC of ACR-TIRADS and C-TIRADS.The corresponding AUC of ACR-TIRADS and C-TIRADS were 0.751 and 0.781 individually,and the differences was not statistically significant(P > 0.05).The sensitivity,specificity,accuracy,missed diagnosis rate,misdiagnosis rate,positive predictive value,negative predictive value between ACR-TIRADS,C-TIRADS and SWE were 75.79%,78.80%,77.20%,24.21%,21.20%,80.71%,73.55% and 80.50%,73.50%,77.30%,19.50%,26.50%,78.05%,76.32% and 83.70%,81.10%,82.50%,16.30%,18.90%,83.80%,80.92%.The difference in the sensitivity,specificity,accuracy,missed diagnosis rate,misdiagnosis rate,positive predictive value,negative predictive value between ACR-TIRADS,C-TIRADS and SWE were not statistically significant(P > 0.05).(2)According to the ROC curve,the optimal cut-off value E max of SWE for the diagnosis of thyroid nodules is 2.49m/s.SWE also showed high-level diagnostic efficacy(P < 0.01)in the group of the thyroid micro-nodules whose diameter less than or equal to 10 mm.The corresponding sensitivity,specificity,accuracy,missed diagnosis rate,misdiagnosis rate,PPV and NPV were 81.37%,89.63%,84.90%,18.63%,10.37%,91.29% and 78.26% respectively.(3)The difference was statistically significant between the AUC of ACR-TIRADS stratification and the combination with SWE(0.751 versus 0.826)(P <0.01);SWE independent diagnosis of AUC was higher than the combined ACR-TIRADS stratification,with a statistically significant difference.(P < 0.01).(4)The AUC under ROC curve of C-TIRADS stratification in the combination with SWE was 0.897,which was higher than that of C-TIRADS stratification and SWE diagnosis separately and independently(P < 0.01).(5)The difference in AUC under the ROC curve for the C-TIRADS versus ACR-TIRADS stratification in the combination with SWE separately(0.897 versus 0.826)was statistically significant(P < 0.01).Conclusion SWE performs satisfied diagnostic efficacy for the differentiation of benign and malignant thyroid nodules,especially thyroid micro-nodules;The stratification of ACR-TIRADS and C-TIRADS in combination with SWE respectively can both improve the diagnostic efficacy of thyroid nodules;The integral diagnostic efficacy of C-TIRADS stratification in combination with SWE is even better than that of ACR-TIRADS stratification in combination with SWE.