Comparison Effectiveness Of 2009 Versus 2015 ATA Guidelines' Ultrasound-based Risk Stratification Models For Thyroid Nodules Fine Needle Aspiration In A Real-world Clinical Setting

Objective:To compare and verify the diagnostic performance and effectiveness of ultrasound-based risk stratification models for thyroid nodules fine needle aspiration biopsy(FNAB)from 2015 Guidelines(short for 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer)and 2009 Guidelines(short for 2009 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer)in a real-world clinical setting.Methods:This study included a series of 2178 thyroid nodules in 1640 patients who underwent ultrasonography-guided FNAB in the First Affiliated Hospital of Xiamen University from April 2014 to December 2016.The sonographic features of thyroid nodules were collected,then the thyroid nodules were respectively classified according to the 2009 and 2015 Guidelines ultrasound-based risk stratification models.Furthermore,the diagnostic performance of ultrasound-based risk stratification models were compared by calculating the area under the ROC curve and net reclassification index(NRI).The effectiveness of ultrasound-based risk stratification models were also compared by calculating unnecessary FNAB rate,malignant nodule number that not founding,nodule number that founding one malignancy and the number of PTMC.Results:(1)Compared with diagnostic performance of ultrasound-based risk stratification models from 2009 Guidelines,the area under the ROC curve(0.719)of 2015 Guidelines is significantly larger than the one(0.542)of 2009 Guidelines(p<0.01).And absolute net reclassification index(NRI)was 45.8%by reclassification of all nodules.(2)Compared with effectiveness of FNBA indications(namely ultrasound-based risk stratification models for thyroid nodules fine needle aspiration)from 2009 Guidelines,2015 Guidelines had fewer nodule number of FNAB(969),lower unnecessary FNAB rate(53.8%),fewer malignant nodule number that not founding(65)and fewer nodule number that founding one malignant nodule required to aspirate(7.34)than nodule number of FNAB(1034),unnecessary FNAB rate(58.1%),malignant nodule number that not founding(67)and nodule number that founding one malignant nodule required to aspirate(7.95)of FNBA indications from 2009 Guidelines.(3)The number of PTMC(16)in nodules that meeting aspiration criteria from 2009 Guidelines was higher than the one(0)that meeting aspiration criteria from 2015 Guidelines(p<0.01).Conclusion:(1)The diagnostic performance of ultrasound-based risk stratification models from 2015 Guidelines is better than the one of 2009 Guidelines.(2)The effectiveness of ultrasound-based risk stratification models from 2015 Guidelines is better than the one of 2009 Guidelines.(3)Combined conclusion one and conclusion two,this study suggests that the ultrasound-based risk stratification models of 2015 Guidelines may be better than the one of 2009 Guidelines.