Department of Radiology and Research Institute of Radiology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Korean J Radiol. 2021 Sep;22(9):1579-1586. doi: 10.3348/kjr.2021.0230. Epub 2021 Jun 1.
To evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS), and compare it with the 2016 version of K-TIRADS using the Thyroid Imaging Network of Korea.
Between June and September 2015, 5708 thyroid nodules (≥ 1.0 cm) from 5081 consecutive patients who had undergone thyroid ultrasonography at 26 institutions were retrospectively evaluated. We used a biopsy size threshold of 2 cm for K-TIRADS 3 and 1 cm for K-TIRADS 4 (modified K-TIRADS 1) or 1.5 cm for K-TIRADS 4 (modified K-TIRADS 3). The modified K-TIRADS 2 subcategorized the K-TIRADS 4 into 4A and 4B, and the cutoff sizes for the biopsies were defined as 1 cm for K-TIRADS 4B and 1.5 cm for K-TIRADS 4A. The diagnostic performance and the rate of unnecessary biopsies of the modified K-TIRADS for detecting malignancy were compared with those of the 2016 K-TIRAD, which were stratified by nodule size (with a threshold of 2 cm).
A total of 1111 malignant nodules and 4597 benign nodules were included. The sensitivity, specificity, and unnecessary biopsy rate of the benign nodules were 94.9%, 24.4%, and 60.9% for the 2016 K-TIRADS; 91.0%, 39.7%, and 48.6% for the modified K-TIRADS 1; 84.9%, 45.9%, and 43.5% for the modified K-TIRADS 2; and 76.1%, 50.2%, and 40.1% for the modified K-TIRADS 3. For small nodules (1-2 cm), the diagnostic sensitivity of the modified K-TIRADS decreased by 5.2-25.6% and the rate of unnecessary biopsies reduced by 19.2-32.8% compared with those of the 2016 K-TIRADS ( < 0.001). For large nodules (> 2 cm), the modified K-TIRADSs maintained a very high sensitivity for detecting malignancy (98%).
The modified K-TIRADSs significantly reduced the rate of unnecessary biopsies for small (1-2 cm) nodules while maintaining a very high sensitivity for malignancy for large (> 2 cm) nodules.
评估改良的韩国甲状腺影像报告和数据系统（K-TIRADS）的诊断性能，并与韩国甲状腺成像网络的 2016 年版 K-TIRADS 进行比较。
2015 年 6 月至 9 月，回顾性分析了 5081 例连续患者的 5708 个甲状腺结节（≥ 1.0cm），这些患者在 26 家机构接受了甲状腺超声检查。我们使用活检大小阈值为 2cm 用于 K-TIRADS 3 和 1cm 用于 K-TIRADS 4（改良 K-TIRADS 1）或 1.5cm 用于 K-TIRADS 4（改良 K-TIRADS 3）。改良 K-TIRADS 2 将 K-TIRADS 4 细分为 4A 和 4B，活检的截止尺寸定义为 K-TIRADS 4B 的 1cm 和 K-TIRADS 4A 的 1.5cm。比较了改良 K-TIRADS 对检测恶性肿瘤的诊断性能和不必要活检率与 2016 年 K-TIRAD 的比较，2016 年 K-TIRAD 按结节大小分层（阈值为 2cm）。
共纳入 1111 个恶性结节和 4597 个良性结节。2016 年 K-TIRADS 的良性结节的灵敏度、特异性和不必要活检率分别为 94.9%、24.4%和 60.9%；改良 K-TIRADS 1 的为 91.0%、39.7%和 48.6%；改良 K-TIRADS 2 的为 84.9%、45.9%和 43.5%；改良 K-TIRADS 3 的为 76.1%、50.2%和 40.1%。对于小结节（1-2cm），与 2016 年 K-TIRADS 相比，改良 K-TIRADS 的诊断灵敏度降低了 5.2-25.6%，不必要活检率降低了 19.2-32.8%（<0.001）。对于大结节（>2cm），改良 K-TIRADSs 仍然对恶性肿瘤具有非常高的检测灵敏度（98%）。
改良的 K-TIRADSs 显著降低了小（1-2cm）结节不必要活检的发生率，同时保持了大（>2cm）结节对恶性肿瘤的高灵敏度。
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