A Comparative Study Of Three Ultrasound Classification Diagnostic Models In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective: To compare the diagnostic efficacy of the thyroid imaging report and data system(Kwak TI-RADS classification)developed by Kwak in 2011,the adult thyroid nodule and differentiated thyroid cancer guidelines(ATA guidelines)issued by the American Thyroid Association(ATA)in 2015,and the thyroid imaging report and data system(TI-RADS)issued by the American College of Radiology(ACR)in 2017.Methods: The ultrasound images of 491 thyroid nodules(295 benign and 196 malignant)from August 2016 to August 2017 in our hospital were analyzed retrospectively.Taking the pathological results as the "gold standard",draw the working characteristic curve of the subjects,determine the best diagnostic critical value of each,calculate the sensitivity,specificity,positive prediction rate,negative prediction rate,accuracy and Youden index of each of the three classification methods,comprehensively analyze the diagnostic value of the three classification methods for thyroid nodules,and compare the diagnostic efficiency.Results: according to Kwak TI-RADS,the nodules were classified into 2,3,4a,4b,4C and 5 categories,with the malignant rate of 0%,8.53%,38.03%,66.18%,87.50%,96.61%respectively.According to ATA guidelines,the nodules were classified into benign,extremely low suspected,moderate suspected and highly suspected,with the malignant rate of 0%,2.94%,7.14%,23.47%,77.5% respectively 6%,another 20 nodules could not be classified by ATA because they did not meet any classification criteria,and their malignant probability was 35.00%;according to ACR TI-RADS,the nodules could be divided into TR1,TR2,TR3,TR4 and TR5,the malignant rates were 4.76%,7.14%,12.22%,33.33% and 77.00% respectively.The area under ROC curve of Kwak TI-RADS,ATA guidelines and ACR TI-RADS in the diagnosis of malignant nodules was 0.906,0.872 and 0.857,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Kwak TI-RADS were 77.04%,89.15%,82.51%,85.38%and 84.31% respectively,and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ATA guidance were 84.12%,respectively 83.68% ?77.56%?88.72%?83.86%.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ACR TI-RADS TR5 were 73.47%,85.42%,77.00%,82.89% and 80.65%,respectively.Conclusion: Three kinds of classification diagnosis models have good diagnosis efficiency for thyroid nodule;Kwak ti-rads has the best overall diagnosis efficiency,which is simple and easy to operate,high repeatability,and suitable for promotion;ATA guide can not classify some nodule,and can not classify nodule with high malignant rate;ACR ti-rads highly suspicious malignant nodule with large malignant probability range and slightly complex use.