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Updated: Dec 5, 2025
A Swin Transformer-Based Model for Thyroid Nodule Detection in Ultrasound Images
Published on: April 21, 2023
Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and
Pyeong Hwa Kim1, Chong Hyun Suh1, Jung Hwan Baek2
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, South Korea.
Objectives:
To summarize and compare unnecessary biopsy rates and diagnostic performance in the examination of thyroid nodules according to four representative US-based risk stratification systems.
Methods:
MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating unnecessary biopsy rates according to at least one of the following guidelines: ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS. The unnecessary biopsy rates for each risk stratification system were pooled using a random-effects model. Meta-regression analyses were performed to explore heterogeneity. Diagnostic odds ratios (DORs) for the appropriate selection of thyroid nodules for fine-needle aspiration were also pooled using a bivariate random-effects model.
Results:
Eight articles including 13,092 thyroid nodules met the eligibility criteria and were included. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22-29%), 51% (95% CI, 44-58%), 38% (95% CI, 16-66%), and 55% (95% CI, 42-67%), respectively. The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001), and also lower than that of EU-TIRADS, but not reaching statistical significance (p = .087). The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6-9.6), 6.3 (95% CI, 4.5-8.8), and 4.5 (95% CI, 1.7-11.6), respectively, with the differences not being statistically significant.
Conclusions:
ACR-TIRADS showed a lower unnecessary biopsy rate than the other risk stratification systems albeit DOR was comparable between ACR-TIRADS, ATA, and K-TIRADS. Future revisions of each system should be made by referring to ACR-TIRADS to reduce unnecessary biopsy rates.
Key Points:
• The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22-29%), 51% (95% CI, 44-58%), 38% (95% CI, 16-66%), and 55% (95% CI, 42-67%), respectively. • The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001). • The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6-9.6), 6.3 (95% CI, 4.5-8.8), and 4.5 (95% CI, 1.7-11.6), respectively, with the differences not being statistically significant.
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