Related Experiment Video
Updated: Sep 28, 2026
Synchronous Triplanar Reconstruction Integrated with Color Doppler Mapping for Precise and Rapid Localization of Thyroid Lesions
Published on: February 9, 2024
BUS TI-RADS 2.0: an optimized study on a malignant risk stratification system for thyroid nodules based on
Sha-Sha Huang1, Yi-Fan Zhu2, Yang-Yang Lei3
1Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Medical Ultrasonics, Shenzhen Children's Hospital, Shenzhen, China.
Objective:
To upgrade the baseline ultrasound thyroid imaging reporting and data system 2.0 (BUS TI-RADS 2.0) by refining nonradiating vascularity subclassification and recalibrating feature weights to enhance diagnostic accuracy and clinical utility.
Methods:
The ultrasonic images of 4852 thyroid nodules of 3639 patients in 4 hospitals (2018-2025) were retrospectively analyzed. "Non-radiating vascularity" was subclassified into five types. Multivariable logistic regression identified predictors to construct BUS TI-RADS 2.0. Its performance was compared with the original BUS TI-RADS, American College of Radiology TI-RADS (ACR TI-RADS), and Chinese TIRADS (C-TIRADS), and biopsy-reducing potential was assessed.
Results:
Multivariate regression confirmed established predictors (e.g., composition, echogenicity, shape, margin, suspected extrathyroidal extension, punctate echogenic foci, vascularity). Diverging from BUS TI-RADS, BUS TI-RADS 2.0 rescored vascularity: circumferential vascularity (-2 points), disorganized vascularity (+1 point), and avascular/punctate/wheel-like vascularity (0 points); "ill-defined margin" was also adjusted to + 1 point. The final score determined risk stratification. BUS TI-RADS 2.0 achieved an AUC of 0.98 in the training set, significantly outperforming BUS TI-RADS (0.97), ACR TI-RADS (0.94), and C-TIRADS (0.93) (all P < 0.001). Internal/external validation confirmed comparable diagnostic value to BUS TI-RADS (AUCs: 0.96 vs. 0.96; 0.94 vs. 0.94) and superiority over others (P < 0.001). The new system markedly reduced false-negative rates (12.98% vs. 18.05%-68.70%), and yielded low overall biopsy recommendations (2.97% vs. 3.53%-34.08%).
Conclusions:
With proven diagnostic performance in trained radiologists, BUS TI-RADS 2.0 may effectively inform clinical decision-making. Broader adoption now depends on validating its consistency across unselected cases and varying reader expertise.