Rationale and Objectives
Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS) was developed to provide
a more simplified tool for stratifying thyroid nodules. Here we aimed to validate
the efficacy of C-TIRADS in distinguishing benign from malignant and in guiding fine-needle
aspiration biopsies in comparison with the American College of Radiology TIRADS (ACR-TIRADS)
and European TIRADS (EU-TIRADS).
Materials and Methods
This study retrospectively included 3438 thyroid nodules (≥10 mm) in 3013 patients
(mean age, 47.1 years ± 12.9) diagnosed between January 2013 and November 2019. Ultrasound
features of the nodules were evaluated and categorized according to the lexicons of
the three TIRADS. We compared these TIRADS by using the area under the receiver operating
characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity,
specificity, net reclassification improvement (NRI), and unnecessary fine-needle aspiration
biopsy (FNAB) rate.
Results
Of the 3438 thyroid nodules, 707 (20.6%) were malignant. C-TIRADS showed higher discrimination
performance (AUROC, 0.857; AUPRC, 0.605) than ACR-TIRADS (AUROC, 0.844; AUPRC, 0.567)
and EU-TIRADS (AUROC, 0.802; AUPRC, 0.455). The sensitivity of C-TIRADS (85.3%) was
lower than that of ACR-TIRADS (89.1%) but higher than that of EU-TIRADS (78.4%). The
specificity of C-TIRADS (76.9%) was similar to that of EU-TIRADS (78.9%) and higher
than that of ACR-TIRADS (69.5%). The unnecessary FNAB rate was lowest with C-TIRADS
(21.2%), followed by ACR-TIRADS (41.7%) and EU-TIRADS (58.3%). C-TIRADS obtained significant
NRI for recommending FNAB over ACR-TIRADS (19.0%, P < 0.001) and EU-TIRADS (25.5%, P < 0.001).
Conclusion
C-TIRADS may be a clinically applicable tool to manage thyroid nodules, which warrants
thorough tests in other geographic settings.
Abbreviations:
ACR-TIRADS (American College of Radiology Thyroid Imaging Reporting and Data System), AUPRC (area under the precision-recall curve), AUROC (area under the receiver operating characteristic curve), C-TIRADS (Chinese Thyroid Imaging Reporting and Data System), EU-TIRADS (European Thyroid Imaging Reporting and Data System), FNAB (fine-needle aspiration biopsy), NRI (Net Reclassification Index)Key Words
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Article info
Publication history
Published online: May 23, 2023
Accepted:
April 14,
2023
Received in revised form:
April 9,
2023
Received:
January 9,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
