Comprision Of Diagnostic Value Between ACR Tirads And Kwak TIRADS

ObjectiveThe main goal of this study was to compare the diagnostic value of ACR TIRADS with Kwak TIRADS.Methods512 preoperative thyroid nodules conventional ultrasound image data from 331 patients were reviewed retrospectively.Those ultrasound images were reviewed by 2 experienced sonographers and classified according to the ACR TIRADS and Kwak TIRADS.ACR TIRADS Classification: The nodules were scored for each sonographic appearance of the nodule,and the total sum of each sonographic appearance was scored.Category 1: 0-1 point;Category 2: 2 point;Category 3: 3 point;Category 4: 4-6 point;Category 5: 7 point and above.Scoring criteria include(1)Composition: cystic or predominately cystic、spongiform nodules 0 points,mixed cystic and solid nodules 1 points,solid or predominately solid nodules 2 points;(2)Echogenicity: anechoic 0 points,hyperechoic or isoechoic 1 point,hypoechoic 2 points,very hypoechoic 3 points;(3)Shape: wider-than-tall 0 points;taller-than-wide 3 points;(4)Margin: smooth 0 points,ill-defined 0 points,lobulated or irregular 2 points,Extra-thyroidal-extension 3 points;(5)Echog-enic Foci: none or large comet-tail artifacts 0 points,macrocalcification 1 points,peripheral calcification 2 points,punctate echogenic foci 3 points.Kwak TIRADS Classification: Category 1: Normal thyroid,not included in classified criteria;Category 2: benign lesions,Including thyroiditis and benign thyroid nodules;Category 3 thyroid nodules without suspicious ultrasound features;Category 4: Suspected nodules including 4a(one suspicious ultrasound feature)4b(two suspicious ultrasound features),4c(three or four suspicious ultrasound features);Category 5: possible malignant nodules(five suspicious ultrasound features).Suspicious malignant ultrasound features includes solid component,hypoechoic or marked hypoechoic,taller-than-wide shape,irregular margins or microlobulated,microcalcifications.The Receiving operating characteristic curves were constructed by using SPSS 19.0 statistical software.The cut-off with best diagnostic were selected and compared with postoperative pathology.The diagnostic value of this two classifications was analyzed and compared by paired chi-square test.Results331 patients were included in this study,74 males and 257 females.With a total of 512 thyroid nodules: 370 benign nodules(72.3%),including 312 nodular goiter,15 Hashimoto’s thyroiditis with nodules,40 adenomas and 3 atrophic lymphocytic thyroiditis.There were 142 malignant nodules(27.7%),including 133 papillary thyroid carcinomas,3 medullary carcinomas,2 follicular carcinomas,2 squamous cell carcinomas and 2 lymphomas.According to the receiver operating characteristic curve(ROC),The best cut-off point of ACR classification was 6.5 points,corresponding to category 4.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under the curve were 81.0%,86.2%,69.3%,92.2%,84.8% and 0.917,respectively.the best cut-off point of Kwak classification is category 4a,and the sensitivity,specificity,positive predictive value,negative predictive value and area under the curve are 79.6%,70.8%,51.1%,90.0%,73.2and 0.809.The area under the curve and the specificity between this two classifications were statistically significant(P<0.001),but the sensitivity between this two classification was no statistically significant(P = 0.850).331 patients were included in this study,74 males and 257 females.With a total of 512 thyroid nodules:370 benign nodules(72.3%),including 312 nodular goiter,15 Hashimoto’s thyroiditis with nodules,40 adenomas and 3 atrophic lymphocytic thyroiditis.There were 142 malignant nodules(27.7%),including 133 papillary thyroid carcinomas,3 medullary carcinomas,2 follicular carcinomas,2 squamous cell carcinomas and 2 lymphomas.According to the receiver operating characteristic curve(ROC),The best cut-off point of ACR classification was 6.5 points,corresponding to category 4.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under the curve were 81.0%,86.2%,69.3%,92.2%,84.8% and 0.917,respectively.the best cut-off point of Kwak classification is category 4a,and the sensitivity,specificity,positive predictive value,negative predictive value and area under the curve are 79.6%,70.8%,51.1%,90.0%,73.2and 0.809.The area under the curve and the specificity between this two classifications were statistically significant(P<0.001),but the sensitivity between this two classification was no statistically significant(P = 0.850).ConclusionsThe ACR TIRADS classification has higher specificity and area under the curve than Kwak TIRADS,but the sensitivity of this two classifications has no significant differences.