Comparison of ACR TI-RADS, Kwak TI-RADS, ATA guidelines and KTA/KSThR guidelines in combination with SWE in the diagnosis of thyroid nodules

Abstract

OBJECTIVE: To compare the diagnostic efficacy of ACR TI-RADS, Kwak TI-RADS, ATA guidelines and KTA/KSThR guidelines in combination with shear wave elastography (SWE) for thyroid nodules. METHODS: The retrospective study included 566 thyroid nodules with maximum diameter≥5 mm which confirmed by FNA cytology or/and surgical pathology. The sensitivity, specificity, accuracy, Youden index of diagnosis of thyroid nodules by ACR TI-RADS, Kwak TI-RADS, ATA guidelines, KTA/KSThR guidelines and SWE were calculated. The ROC curve was drawn to determine the cut-off values of the four ultrasound classification systems and SWE Emax. The diagnostic efficacy of the four ultrasound classification systems in combination with SWE were calculated and compared with those of pre-combination. RESULTS: The ROC curves indicated that the cut-off value of ACR TI-RADS, Kwak TI-RADS, ATA guidelines, KTA/KSThR guidelines and Emax of SWE was TR5, 4c, high-suspicion, high-suspicion, and 41.7 kPa, respectively, and the area under the ROC curve (AUC) was 0.907(0.879–0.934), 0904(0.876–0.932), 0.894(0.863–0.924), 0.888(0.856–0.919), 0.886(0.859–0.913), respectively. After combination with SWE, the the sensitivities of the four ultrasound classification systems for the diagnosis of nodules were improved, and the differences were statistically significant (all P≤0.001); the specificities were decreased, but the differences were not statistically significant (all P > 0.05); the accuracies were improved, but only the difference of ACR TI-RADS was statistically significant (x2 = 4.45, p = 0.035); the differences in the AUCs were not significant (all P > 0.05). CONCLUSIONS: The four ultrasound classification systems and SWE all had high performance in the diagnosis of thyroid nodules. The four classification systems in combination with SWE were all beneficial to the differential diagnosis of nodules, and ACR TI-RADS in combination with SWE was more effective, especially for TR3 and TR4 nodules.

Diagnostic Performance of ACR and Kwak TI-RADS for Benign and Malignant Thyroid Nodules: An Update Systematic Review and Meta-Analysis

“…Higher DOR values (ranging from 0 to infinity) indicated better diagnostic performance. The SROC approach is considered the best method for meta-analysis and generates paired sensitivity and specificity estimates [ 6 , 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. As the discriminatory power of a test increases, the SROC curve more closely approaches the top left corner of the receiver operating characteristic curve (ROC) space (i.e., the point where sensitivity and specificity both equal 1 (100%)) [ 56 ].…”

Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules—Results of a Prospective Study

“…Comparably, we found the AUC = 0.79 (0.61; 0.98) for the optimal cutoff of SWE to distinguish malignant from benign nodules. Zhang et al described, in combination with SWE, that the sensitivity of Kwak-TIRADS for the diagnosis of nodules was improved, the difference was statistically significant ( p ≤ 0.001) and the specificity was decreased, but the difference was not statistically significant ( p > 0.05) [ 37 ]. The difference in the AUC was not significant ( p > 0.05).…”

Clinical diagnostic value of American College of Radiology thyroid imaging report and data system in different kinds of thyroid nodules

“…A previous study was conducted to compare the diagnostic ability of the KSThR guideline, European Thyroid Society (ETA) and ACR TI-RADS in distinguishing benign from malignant thyroid lesions, which revealed that KSTHR TI-RADS had the best diagnostic specificity, while ACR TI-RADS had the best sensitivity [ 24 ]. As shown in the study of Zhang et al, the AUC value of the diagnostic performance of ACR TI-RADS in thyroid nodules was 0.907, which was higher than Kwak TI-RADS (0.904), ATA guidelines (0.894) and KTA/KSThR guidelines (0.888) [ 25 ]. The sensitivity (85.7%) and NPV (98.3%) of ACR TI-RADS were both higher than EU TI-RADS and the specificity of ACR TI-RADS (51.1%) was higher than Kwak TI-RADS [ 26 ].…”