Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules

Abstract

The thyroid imaging reporting and data system (TIRADS) was proposed by experts for optimal ultrasound evaluation of malignancy risk of thyroid focal lesions. There are several versions of TIRADS, some of them have been validated sufficiently, and the others have not been well assessed. In this study, a recently launched Chinese version of TIRADS (C-TIRADS) for malignancy risk stratification of thyroid nodules was validated, and the performance was compared to that of the Korean TIRADS (K-TIRADS) and American College of Radiology(ACR) TIRADS (ACR-TIRADS). Archives of 2177 patients who had undergone thyroid ultrasound examination, coarse needle tissue biopsy and/or surgery were reviewed, and 1978 patients with 1982 thyroid nodules were assessed according to the three TIRADSs. The histopathology was taken as the golden standard. The results showed the 1982 thyroid nodules were consisted of 1306 benign nodules and 676 malignant nodules. The malignancy risk accounted for 1.09%, 2.14%, 10.34%, 49.28%, 88.19% and 85.29% of the total nodules that were categorised as C-TIRADS 2, 3, 4A, 4B, 4C and 5, respectively; 0.00%, 1.64%, 2.87%,18.71% and 82.22% of the total nodules that were categorised as ACR-TIRADS 1, 2, 3, 4 and 5, respectively; 0.85%, 3.27%, 24.27% and 80.96% of the total nodules that were categorised as K-TIRADS 2, 3, 4 and 5, respectively. The correlation between the category of TIRADS and percentile of malignancy was 0.94 in the C-TIRADS, 1.00 in the ACR-TIRADS, and 1.00 in the K-TIRADS, respectively. The highest values of accuracy(AUC) of ROC curves of C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 were taken as the cut-off values for risk stratification, respectively. The sensitivity, specificity, positive and negative predictive values and AUC by C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 for malignancy risk stratification of thyroid nodules were 90.83%, 84.23%, 74.88% and 94.66% and 0.88, respectively; 83.58%, 89.82%, 80.95%, 91.36% and 0.87, respectively; and 85.50%, 90.35%, 82.10%, 92.33% and 0.88, respectively (P>0.05 for all). We concluded that the C-TIRADS has excellent performance in the malignancy risk stratification of thyroid nodules by the optimized cut-off value, which is comparable to that in K-TIRADS and ACR-TIRADS.

A new discriminant strategy combined with four TIRADS screening procedures increases ultrasound diagnostic accuracy—focusing on “wrong diagnostic” thyroid nodules

“…In this study, the sensitivity of the four TIRADS ranged from 81.4 to 91.6%, specificity from 80.9 to 91.1%, and AUC 0.863 to 0.884, which indicates that all TIRADS have a good diagnostic performance. C-TIRADS has the highest sensitivity, while ACR-TIRADS has the highest specificity, consistent with the results of previous studies [ 16 – 18 ]. The classification screening results corroborated our hypothesis that the partially inconsistently diagnosed results of the four TIRADS for some nodules are precisely the reason for their differential diagnostic performance.…”

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 ].…”

Diagnostic efficiency among Eu-/C-/ACR-TIRADS and S-Detect for thyroid nodules: a systematic review and network meta-analysis

“…After meta-analysis, in the best risk category threshold TR5 of Eu-TIRADS, sensitivity ranged from 66% to 82%; specificity ranged from 75% to 87%; and accuracy ranged from 74% to 82%. 13 studies evaluated C-TIRADS ( 20 , 69 , 70 , 72 , 80 , 87 , 120 , 137 – 142 ), with sensitivity ranging from 70% (C-TIRADS TR4c) to 95% (C-TIRADS TR4a); specificity ranging from 54% (C-TIRADS TR4a) to 92% (C-TIRADS TR4c); and accuracy ranging from 75% (C-TIRADS TR4a) to 88% (C-TIRADS TR4b). 12 studies evaluated S-Detect ( 45 , 46 , 65 , 112 , 114 , 133 , 134 , 143 – 147 ), with sensitivity ranging from 73% to 88%; specificity ranging from 66% to 86%; accuracy ranging from 72% to 83%.…”