Objective

To evaluate and compare the diagnostic performances between recently published pattern-based and score-based TIRADS according to the experience level of the performer.

Methods

From July 2013 to January 2019, 8657 thyroid nodules in 8364 patients that had been cytopathologically diagnosed as benign or malignant were included (mean size, 22.0 mm ± 12.1). Thyroid nodules were categorized into US-based final assessment categories and US-FNA indications of five recently published TIRADS. Radiologists performing the US examinations were divided into the experienced vs. inexperienced group. Diagnostic performances and unnecessary biopsy rates were calculated and compared between the five TIRADS, also the experienced vs. inexperienced group.

Results

Of the 8657 thyroid nodules, 6706 (77.5%) were benign and 1951 (22.5%) were malignant. Diagnostic performances for US-based final assessment categories showed higher sensitivity and NPV for EU-TIRADS (92.7% and 96.5%), while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC (89.6%, 68.0%, 86.5%, and 0.878; all p < 0.05, respectively). Diagnostic performances for US-FNA indications showed higher sensitivity and NPV for KTA/KSThR TIRADS (98.5% and 97.0%), while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC (70.3%, 46.6%, 74.5%, and 0.797; all p < 0.05, respectively). Unnecessary biopsy rates were the lowest in Kwak-TIRADS for both US categories and US-FNA indications (32.0% and 53.4%, p < 0.001). Similar trends were seen in both the experienced and inexperienced group.

Conclusion

The currently published score-based guidelines for thyroid nodules have significantly higher specificity, PPV, accuracy, and AUC and lower unnecessary biopsy rates, whereas pattern-based guidelines have higher sensitivity and NPV, regardless of the level of experience of the performer.

Key Points

• For US-based final assessment categories, EU-TIRADS had higher sensitivity and NPV, while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC.

• For US-FNA indications, KTA/KSThR TIRADS had higher sensitivity and NPV, while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC.

• Similar trends were seen in diagnostic performances for both experienced and inexperienced groups.

中文翻译：

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使用超声功能的基于模式和基于评分的指南在甲状腺结节的风险分层方面具有不同的优势。

目的

根据表演者的经验水平，评估和比较最近发布的基于模式的TIRADS和基于分数的TIRADS的诊断性能。

方法

从2013年7月至2019年1月，纳入了8364例经细胞病理学诊断为良性或恶性的甲状腺结节（平均大小，22.0 mm±12.1）。甲状腺结节分为基于美国的最终评估类别和最近发布的五个TIRADS的US-FNA适应症。进行美国检查的放射科医生分为有经验组和无经验组。计算了五个TIRADS的诊断性能和不必要的活检率，并对有经验和无经验的组进行了比较。

结果

在8657个甲状腺结节中，有6706个（77.5％）是良性的，而1951年（22.5％）是恶性的。基于美国的最终评估类别的诊断性能显示，EU-TIRADS的敏感性和NPV较高（分别为92.7％和96.5％），而Kwak-TIRADS的特异性，PPV，准确性和AUC较高（89.6％，68.0％，86.5％，和0.878；所有p均 <0.05）。US-FNA适应症的诊断性能显示，KTA / KSThR TIRADS的敏感性和NPV更高（分别为98.5％和97.0％），而Kwak-TIRADS的特异性，PPV，准确性和AUC更高（70.3％，46.6％，74.5％和0.797；所有p均 <0.05）。对于美国类别和US-FNA指征，不必要的活检率在Kwak-TIRADS中最低（分别为32.0％和53.4％，p <0.001）。在有经验和没有经验的人群中都看到了类似的趋势。

结论

当前发布的基于评分的甲状腺结节指南具有更高的特异性，PPV，准确性和AUC，并降低了不必要的活检率，而基于模式的指南则具有更高的敏感性和NPV，而与表演者的经验水平无关。

关键点

•对于基于美国的最终评估类别，EU-TIRADS具有更高的敏感性和NPV，而Kwak-TIRADS具有更高的特异性，PPV，准确性和AUC。

•对于US-FNA适应症，KTA / KSThR TIRADS具有更高的灵敏度和NPV，而Kwak-TIRADS具有更高的特异性，PPV，准确性和AUC。

•对于经验丰富和经验不足的人群，在诊断表现中都观察到了类似的趋势。