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

Article type: Research Article

Authors: Zhang, Wei-Bing^{a; 1} | Xu, Wen^{b; 1} | Fu, Wen-Jie^c | He, Bei-Li^a | Liu, Hua^a | Deng, Wen-Fang^{d; *}

Affiliations: [a] Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China | [b] Department of Medical Imaging, Beijing Provincial Corps Hospital, Chinese People’s Armed Police Forces, Beijing, China | [c] Department of Surgery, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China | [d] Department of Orthopedics, Subei People’s Hospital of Jiangsu Province, Yangzhou, China

Correspondence: [*] Correspondence to: Wen-Fang Deng, Department of Orthopedics, Subei People’s Hospital of Jiangsu Province, No. 98, Nantong West Road, Yangzhou 225001, China. Tel: +86 514 87373012; E-mail: 67493026@qq.com.

Note: [1] These authors contributed equally to this work.

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.

Keywords: Thyroid nodules, thyroid ultrasound classification system, thyroid imaging reporting and data system, shear wave elastography

DOI: 10.3233/CH-201021

Journal: Clinical Hemorheology and Microcirculation, vol. 78, no. 2, pp. 163-174, 2021