A real-world comparison of the diagnostic performances of six different TI-RADS guidelines, including...

Area of Science:

• Radiology
• Oncology
• Endocrinology

Background:

• Thyroid nodules (TN) are common, and accurate differentiation between benign and malignant types is crucial for appropriate patient management.
• Several Thyroid Imaging Reporting and Data System (TIRADS) guidelines exist, but their comparative diagnostic performance needs further evaluation.

Purpose of the Study:

• To compare the diagnostic performance of six current TIRADS guidelines in differentiating malignant from benign thyroid nodules (TN).
• The guidelines evaluated include American College of Radiology (ACR-TIRADS), Kwak-TIRADS, Korean (K-TIRADS), European (EU-TIRADS), American Thyroid Association (ATA), and Chinese (C-TIRADS).

Main Methods:

• Retrospective analysis of 829 pathologically proven thyroid nodules (234 malignant, 595 benign) between January 2007 and September 2023.
• Ultrasound images were categorized using the six different TIRADS guidelines.
• Diagnostic performance metrics, including Area Under Curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV, NPV), and miss rates for malignancy (MRM), were calculated for each guideline.

Main Results:

• All six guidelines demonstrated effective differentiation of malignant from benign TNs with comparable diagnostic performances.
• Chinese TIRADS (C-TIRADS) exhibited the highest AUC (0.842) and the lowest miss rate for malignancy (0.1%).
• Specific performance varied, with C-TIRADS showing 92.8% specificity and 68.8% accuracy, while ACR-TIRADS had 99.8% sensitivity but only 27.1% specificity.

Conclusions:

• Six current TIRADS guidelines offer effective differentiation of malignant from benign thyroid nodules.
• C-TIRADS demonstrated superior performance in this study, evidenced by the highest AUC and lowest miss rate for malignancy.
• The findings suggest C-TIRADS may be a more optimal choice for thyroid nodule risk stratification.