Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Oct;36(5):1111-1120. doi: 10.3803/EnM.2021.1208. Epub 2021 Oct 21.
The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules.
Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled.
Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change.
K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.
细胞学不确定的甲状腺结节的管理对临床医生来说具有挑战性。本研究旨在比较韩国甲状腺影像报告和数据系统（K-TIRADS）与美国放射学院（ACR）-TIRADS 对预测不确定甲状腺结节恶性风险的诊断性能。
在一家转诊医院，通过细针抽吸（FNA）诊断的甲状腺结节随后进行手术或核心针活检。
在 200 个甲状腺结节中，78 个（39.0%）结节通过 FNA 被归类为不确定（Bethesda 类别 III、IV 和 V），114 个（57.0%）结节最终通过手术或核心针活检被诊断为恶性。在所有结节中，FNA 的曲线下面积（AUC）均高于两种 TIRADS 系统，而所有三种方法对不确定结节的 AUC 均相似。然而，对于 Bethesda 类别 III 结节，与单独细胞学检查相比，应用 K-TIRADS 5 显著增加了恶性风险（50.0%比 26.5%，P=0.028），而应用 ACR-TIRADS 则没有改变。
K-TIRADS 和 ACR-TIRADS 在评估不确定甲状腺结节方面表现出相似的诊断性能，并且 K-TIRADS 对 Bethesda 类别 III 结节的恶性预测具有有益影响。
