A comparative study of the diagnostic efficacy of C-TIRADS and ACR-TIRADS for thyroid nodules
Objective To comparatively study the diagnostic efficacy of the Chinese-Thyroid Imaging Reporting and Data System(C-TIRADS)developed by the Chinese Medical Association and the American College of Radiology Thyroid Imaging Reporting and Data System(ACR-TIRADS)for thyroid nodules.Methods A retrospective analysis was conducted on the ultrasound images of 511 patients(527 nodules)with thyroid nodules confirmed by surgical pathology.The nodules were classified according to the C-TIRADS and ACR-TIRADS criteria,respectively.Using pathological results as the gold standard,the malignancy rates of each category were calculated and compared with the guideline-recommended malignancy rates;receiver operating characteristic(ROC)curves were drawn,and the area under the curve(AUC)was calculated.The optimal cutoff value for each category was determined based on the Youden's index,and the sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of the two TIRADS for benign and malignant of thyroid nodules were evaluated based on the optimal cutoff value.Results The pathologic findings showed that there were 333 benign nodules of the 527 nodules,including 311 nodules of nodular goiter,12 nodules of adenomas,3 nodules of Hashimoto's thyroiditis,3 nodules of subacute thyroiditis,3 nodules of simple cysts,and 1 nodule of granulomatous nodule;194 nodules were malignant,including 182 v papillary carcinoma,8 nodules of follicular carcinoma,2 nodules of medullary carcinoma,and 2 nodules of metastatic carcinoma.With pathologic findings as the gold standard,the malignancy rates of C-TIRADS categories 2,3,4A,4B,4C,and 5 were 0,1.97%,10.34%,46.58%,88.19%,and 91.67%,respectively;the malignancy rates of ACR-TIRADS categories 1,2,3,4,and 5 were 0,1.30%,3.73%,20.18%,and 83.42%,respectively.Comparison of malignancy rates of each category of C-TIRADS showed statistically significant differences(P<0.05).Comparison of malignancy rates of each category of ACR-TIRADS,the difference was statistically significant(P<0.05).With the exception of C-TIRADS category 5 and ACR-TIRADS categories 3-5,where the malignancy rate was higher than the guideline-recommended malignancy rate,the actual malignancy rate for each category was lower than the guideline-recommended malignancy rate or was generally in line with the guideline-recommended malignancy rate.The AUC of C-TIRADS and ACR-TIRADS were 0.865 and 0.864 for the diagnosis of benign and malignant nodules,respectively,with comparable AUC.The optimal cutoff value for C-TIRADS was category 4B,and the optimal cutoff value for ACR-TIRADS was category 5.The sensitivity,specificity,PPV,and NPV of C-TIRADS and ACR-TIRADS were 92.27%(179/194),82.88%(276/333),75.85%(179/236),94.85%(276/291),85.57%(166/194),90.09%(300/333),83.42%(166/199),91.46%(300/328).The sensitivity of C-TIRADS was higher than that of ACR-TIRADS,and the specificity was lower than that of ACR-TIRADS,with statistical significance(P<0.05).The NPV of C-TIRADS was slightly higher than that of ACR-TIRADS,and the PPV of C-TIRADS was slightly lower than that of ACR-TIRADS,with no statistical significance(P>0.05).Conclusion Both C-TIRADS and ACR-TIRADS have high diagnostic value for differentiating benign and malignant thyroid nodules,with comparable diagnostic efficacy.However,C-TIRADS is simpler and easier to use compared to ACR-TIRADS.
Chinese-Thyroid Imaging Reporting and Data SystemAmerican College of RadiologyUltrasound imageThyroid noduleBenign and malignant
NETL
NSTL
万方数据
