Comparative Study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for Diagnosis and Management of Thyroid Nodules

Zhe Jin; Shufang Pei; Hui Shen; Lizhu Ouyang; Lu Zhang; Xiaokai Mo; Qiuying Chen; Jingjing You; Shuixing Zhang; Bin Zhang

doi:10.1016/j.acra.2023.04.013

Comparative Study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for Diagnosis and Management of Thyroid Nodules

Acad Radiol. 2023 Oct;30(10):2181-2191. doi: 10.1016/j.acra.2023.04.013. Epub 2023 May 23.

Authors

Zhe Jin¹, Shufang Pei², Hui Shen¹, Lizhu Ouyang³, Lu Zhang¹, Xiaokai Mo¹, Qiuying Chen¹, Jingjing You¹, Shuixing Zhang¹, Bin Zhang⁴

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.).
² Department of Ultrasound, Guangdong Provincial People's Hospital/ Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China (S.P.).
³ Department of Ultrasound, Shunde Hospital of Southern Medical University, Foshan, China (L.O.).
⁴ Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.). Electronic address: xld_Jane_Eyre@126.com.

PMID: 37230821
DOI: 10.1016/j.acra.2023.04.013

Abstract

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.

Keywords: Fine-needle aspiration biopsy; Guideline; Thyroid nodule; Ultrasonography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Data Systems
Humans
Middle Aged
Retrospective Studies
Thyroid Neoplasms* / diagnosis
Thyroid Nodule* / pathology
Ultrasonography / methods