Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS' size thresholds for FNA

Sun Huh; Jung Hyun Yoon; Hye Sun Lee; Hee Jung Moon; Vivian Youngjean Park; Jin Young Kwak

doi:10.1007/s00330-020-07591-1

Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS' size thresholds for FNA

Eur Radiol. 2021 Jul;31(7):5243-5250. doi: 10.1007/s00330-020-07591-1. Epub 2021 Jan 15.

Authors

Sun Huh¹, Jung Hyun Yoon², Hye Sun Lee³, Hee Jung Moon², Vivian Youngjean Park², Jin Young Kwak⁴

Affiliations

¹ Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea.
² Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
³ Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea. docjin@yuhs.ac.

PMID: 33449191
DOI: 10.1007/s00330-020-07591-1

Abstract

Objective: To investigate the diagnostic performances and unnecessary fine-needle aspiration (FNA) rates of two point-scale based TIRADS and compare them with a modified version using the ACR TIRADS' size thresholds.

Methods: Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. A total of 2106 thyroid nodules 10 mm or larger in size in 2084 patients with definitive cytopathologic findings were included. Ultrasonography categories were assigned according to each guideline. We applied the ACR TIRADS' size thresholds for FNA to the Kwak TIRADS and defined it as the modified Kwak TIRADS (mKwak TIRADS). Diagnostic performances and unnecessary FNA rates were evaluated for both the original and modified guidelines.

Results: Of the original guidelines, the ACR TIRADS had higher specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant mKwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. The mKwak TIRADS also had a lower unnecessary FNA rate than the ACR TIRADS (54.8% and 56.4%, respectively). The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.

Conclusion: The modified Kwak TIRADS incorporating the size thresholds of the ACR TIRADS showed higher diagnostic performance and a lower unnecessary FNA rate than the original point-scale based TIRADS.

Key points: • Of the original guidelines, the ACR TIRADS had the highest specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). • When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant modified version of Kwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. • The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.

Keywords: Biopsy, fine-needle; Thyroid gland; Thyroid neoplasm; Thyroid nodule; Ultrasonography.

MeSH terms

Biopsy, Fine-Needle
Humans
ROC Curve
Retrospective Studies
Thyroid Neoplasms*
Thyroid Nodule*
Ultrasonography