Comparison of diagnostic accuracy of ACR-TIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy

Koç, Ali Murat; Adıbelli, Zehra Hilal; Erkul, Zehra; Şahi̇n, Yasemin; Dilek, Ismail

doi:10.1016/j.ejrad.2020.109390

Cited by 37 publications

(44 citation statements)

References 23 publications

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“…For these systems, diagnostic accuracy is similar, with high sensitivity and low specificity [ 31 , 32 ]. In our study, ACR TIRADS sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%; for K-TIRADS—97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for EU-TIRADS —97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively, and these results are similar to other authors’ research results [ 33 , 34 , 35 ].…”

Section: Discussionsupporting

confidence: 91%

Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

Popova

Radziņa

Prieditis

et al. 2021

Cancers

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Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity.

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Section: Discussionsupporting

confidence: 91%

Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

Popova

Radziņa

Prieditis

et al. 2021

Cancers

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“…ROC was used to analyze the diagnostic performance of the four guidelines. First, the diagnostic cut-offs of the four guidelines, ACR-TIRADS TR5, Kwak-TIRADS 4C, KTA/KSThR-TIRADS 5, and EU-TIRADS 5 were identified, which was similar to that of Gao, Ali Murat Koc ( 14 , 20 ). However, Simone indicated that the diagnostic cut-off value of ACR-TIRADS is TR4, while Du showed that the diagnostic cut-off value of Kwak-TIRADS is 4B ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 72%

Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study

Aiyun

Guo

et al. 2021

Front. Endocrinol.

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PurposeTo explore the characteristics of C-TIRADS by comparing it with ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS and EU-TIRADS.MethodsA total of 1096 nodules were collected from 884 patients undergoing thyroidectomy in our center between May 2018 and December 2020. Divided the nodules into two groups: “>10mm” and “≤10mm”. Ultrasound characteristics of each nodule were observed and recorded by 2 doctors, then classified based on ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS, EU-TIRADS, and C-TIRADS.ResultsA total of 682 benign nodules cases (62.23%) and 414 malignant nodules cases (37.77%) were identified. The ICC value of each guideline was:0.937(ACR-TIRADS), 0.858(EU-IRADS), 0.811(Kwak-TIRADS), 0.835(KTA/KSThR-TIRADS) and 0.854(C-TIRADS). The nodule malignancy rates in the groups(Kwak-TIRADS 4B, C-TIRADS 4B、4C) of two sizes were significantly different (all p<0.05). There was no statistical difference in the other grades of two sizes (all p>0.05). Unnecessary biopsy rates were the lowest in C-TIRADS (49.02% p<0.001). Furthermore, Kwak-TIRADS had the highest sensitivity and NPV (89.9%, 91.0%, all p<0.05), while C-TIRADS had the highest specificity and PPV (82.3%, 69.2%, all p<0.05). C-TIRADS and Kwak-TIRADS had the highest accuracy (76.0%, 72.5%, P=0.071). The AUCs of the 5 guidelines were C-TIRADS(0.816, P<0.05), Kwak-TIRADS(0.789, P<0.05) KTA/KSThR-TIRADS and ACR-TIRADS(0.773, 0.763, P=0.305), EU-TIRADS(0.734, P<0.05). The AUCs of the five guidelines were not statistically different between “nodules>10mm” and “nodules ≤ 10mm” (all P>0.05).ConclusionsAll five guides showed excellent interobserver agreement. C-TIRADS was slightly efficient than Kwak-IRADS, KTA/KSThR-TIRADS and ACR-TIRADS, and had greater advantages than EU-TIRADS. The diagnostic abilities of the five guidelines for “nodules ≤ 10mm” were not inferior to that of “nodules> 10mm”. C-TIRADS is simple and easy to implement and can provide effective thyroid tumor risk stratification for thyroid nodule diagnosis, especially in China.

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“…At present, several versions of RSSs exist worldwide. Some studies confirmed that ACR-TIRADS had high diagnostic efficiency in differentiating between benign and malignant TNs and a better performance in avoiding unnecessary FNA, but did not have the highest sensitivity among RSSs (16,(24)(25)(26). For TIRADS 4 TNs, many FNA results were benign, which increased the unnecessary puncture risk and economic burden for patients (6,26).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules

Liu

Xie

et al. 2022

Front. Oncol.

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BackgroundConventional ultrasound diagnosis of thyroid nodules (TNs) had a high false-positive rate, resulting in many unnecessary fine-needle aspirations (FNAs).ObjectiveThis study aimed to establish a simple algorithm to reduce unnecessary FNA on TIRADS 4 TNs using different quantitative parameters of ultrasonic elasticity and chi-square automatic interactive detector (CHAID) method.MethodsFrom January 2020 to May 2021, 432 TNs were included in the study, which were confirmed by FNA or surgical pathology. Each TN was examined using conventional ultrasound, sound touch elastography, and Shell measurement function. The quantitative parameters E and Eshell were recorded, and the Eshell/E values were calculated for each TN. The diagnostic performance of the quantitative parameters was evaluated using the receiver operating characteristic curves. The CHAID was used to classify and analyze the quantitative parameters, and the prediction model was established.ResultsA total of 226 TNs were malignant and 206 were benign. Eshell and Eshell/E ratio were included in the classification algorithm, which showed a depth of two ramifications (Eshell/E ≤ 0.988 or 0.988–1.043 or >1.043; if Eshell/E ≤ 0.988, then Eshell ≤ 64.0 or 64.0–74.0 or >74.0; if Eshell/E = 0.988–1.043, then Eshell ≤ 66.0 or > 66.0; if Eshell/E >1.043, then Eshell ≤ 69.0 or >69.0). The unnecessary FNAs could have been avoided in 57.3% of the cases using this algorithm.ConclusionThe prediction model using quantitative parameters had high diagnostic performance; it could quickly distinguish benign lesions and avoid subjective influence to some extent.

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Comparison of diagnostic accuracy of ACR-TIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy

Cited by 37 publications

References 23 publications

Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study

Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules

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