Chinese thyroid imaging reporting and data system with redefined marked hypoechogenicity for thyroid malignancy risk...

Area of Science:

• Radiology and Imaging
• Oncology
• Endocrinology

Background:

• Distinguishing benign from malignant thyroid nodules via ultrasound presents diagnostic challenges.
• Current thyroid nodule classification systems require refinement for improved malignancy risk stratification.

Purpose of the Study:

• To evaluate the diagnostic performance of a modified Chinese Thyroid Imaging Reporting and Data System (C-TIRADS).
• To assess the impact of a redefined criterion for marked hypoechogenicity in stratifying thyroid nodule malignancy risk.

Main Methods:

• Retrospective analysis of 1,219 patients with 1,721 thyroid nodules undergoing ultrasound and subsequent biopsy/treatment.
• Interobserver agreement for marked hypoechogenicity was assessed using kappa statistics.
• Diagnostic performance (sensitivity, specificity, accuracy, AUC) of modified C-TIRADS, classical C-TIRADS, and K-TIRADS was compared using histopathology as the reference standard.

Main Results:

• Redefining marked hypoechogenicity improved interobserver agreement (kappa from 0.652 to 0.722) and significantly enhanced sensitivity (74.5% vs. 15.1%) and accuracy (86.8% vs. 70.8%).
• Modified C-TIRADS demonstrated superior accuracy (90.2%) and AUC (0.908) compared to classical C-TIRADS (88.2%, 0.870) and K-TIRADS (81.3%, 0.857).
• Malignancy rates for modified C-TIRADS categories were 12.0% (4a), 60.6% (4b), 85.8% (4c), and 93.3% (5).

Conclusions:

• The modified C-TIRADS, with its redefined marked hypoechogenicity criterion, significantly improves diagnostic performance for thyroid nodule malignancy risk stratification.
• This enhanced system provides risk assessments that more closely align with expected probabilities, aiding clinical decision-making.