Comparative Study On Diagnostic Efficiency Of Different Risk Stratification Systems For Thyroid Nodules

Objectives The aim of this study was to compare the diagnostic performance and the number of unnecessary thyroid biopsies reduction of the 2020 Chinese Guidelines for Ultrasonographic Malignancy Risk Stratification of Thyroid Nodules(C-TIRADS),the American College of Radiology Thyroid Imaging Reporting and Data System(ACRTIRADS),the Korean Thyroid Imaging Reporting and Data System(K-TIRADS)for thyroid nodules.Methods We retrospectively identified 1056 thyroid nodules in 883 patients who underwent thyroid nodules resection in our hospital from May 2017 to June 2021.We collected general information such as sex,age,and medical history of patients.We recorded location,maximum diameter,composition,echo,shape,edge,calcification and other characteristics of nodules.According to the maximum diameter of the nodules,they were divided into two groups,nodules at least 1cm of maximum diameter and the maximum diameter of nodules less than 1cm.Each nodule was analyzed on the basis of three risk stratification systems:C-TIRADS,ACR-TIRADS,and K-TIRADS.We compared the diagnostic performance and evaluated whether FNA performed for nodules at least 1cm of maximum diameter.Quantitative data were expressed in terms of median or extremum,and qualitative data were expressed in the number of cases or percentages.The comparison between quantitative data groups used independent sample t-test,nonparametric rank and test,and χ2 test was used between qualitative data groups.Taking the pathological results as the gold standard,the SPSS 26.0 statistical software was used to establish the ROC curve,the optimal diagnostic critical value of the three risk stratification systems and the corresponding sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and areas under the ROC curves were obtained,and the diagnostic efficiency of the three risk stratification systems on thyroid nodules was compared.R statistical software established a decision curve,the pathological results were the gold standard,the malignancy rate of nodules in this group of data is corrected by 15%.A decision curve was used to compare the net benefit and the number of unnecessary thyroid biopsies reduction in nodules at least lcm of maximum diameter.P<0.05 was considered statistically significant.Results 1 ACR-TIRADS and C-TIRADS showed higher sensitivity than K-TIRADS(P<0.05),the highest specificity was observed with the K-TIRADS(P<0.05).2 The areas under the ROC curves of ACR-TIRADS and K-TIRADS were not significantly different.However,they were more significant than that of C-TIRADS(P<0.05).3 The ROC curve showed that the areas under the curves corresponding to C-TIRADS,ACR-TIRADS and K-TIRADS is 0.75,0.79 and 0.78 for nodules with a maximum diameter of<1cm.The area under the curves corresponding to C-TIRADS,ACR-TIRADS and K-TIRADS is 0.85,0.88 and 0.90 for nodules with a maximum diameter of ≥1cm.4 For nodules with a maximum diameter of<1cm,C-TIRADS showed higher sensitivity than KTIRADS(P<0.05),ACR-TIDADS and K-TI-RADS showed higher specificity and positive likelihood ratios than C-TIRADS(P<0.05),the difference in negative likelihood ratio between the three risk stratification systems was not statistically significant.ACRTIRADS showed higher diagnostic efficiency compared with C-TIRADS(P<0.05).5 For nodules with a maximum diameter of ≥1cm,both ACR-TIDADS and C-TIRADS showed higher sensitivity than K-TIRADS(P<0.05),the highest specificity and positive likelihood ratios was observed with K-TIRADS(P<0.05),and K-TIRADS showed higher negative likelihood ratios than ACR-TIDADS(P<0.05).6 In the threshold probability range of 3.5%to 50%,the FNA strategy recommended in ACR-TIRADS can achieve higher net benefit compared to C-TIRADS and K-TIRADS,which showed significantly higher reductions in the number of procedures.Conclusions 1 Compared to C-TIRADS,ACR-TIRADS and K-TIRADS performed well in distinguishing benign from malignant thyroid nodules.2 Compared with nodules with a maximum diameter of<1 cm,the three guidelines have better diagnostic efficiency in evaluating nodules with a maximum diameter of ≥1 cm.3 Compared to C-TIRADS and K-TIRADS,ACR-TIRADS performed better at reducing the number of unnecessary thyroid nodule FNAs in the threshold probability range of 3.5%to 50%.Figure 1;Table 6;Reference 171...