Huang Hu, Zhu Ming-Jie, Gao Qi, Huang Yan-Li, Li Wei-Min
Department of Thyroid and Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, People's Republic of China.
Department of Ultrasonography, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, People's Republic of China.
Int J Gen Med. 2023 Sep 29;16:4441-4451. doi: 10.2147/IJGM.S429681. eCollection 2023.
To compare the diagnostic value of the Thyroid Imaging Reporting and Data System (TI-RADS) of the American College of Radiology (ACR) versus the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) scoring and classification system for elderly thyroid cancers.
A total of 512 nodules from 465 patients aged ≥60 with surgical pathology-proven thyroid nodules were enrolled in our study. The ultrasound features of thyroid nodules were independently evaluated by the ACR TI-RADS and C-TIRADS classification systems, and the receiver operating characteristic curve (ROC) was plotted. The optimal cut-off values of the ACR TI-RADS and C-TIRADS scoring and classification systems for diagnosing elderly thyroid nodules were estimated, and the diagnostic efficacy was analyzed.
The ACR TI-RADS and C-TIRADS scores and classifications of thyroid cancers were both higher than benign nodules (both < 0.05). The area under the curve (AUC) of ACR TI-RADS and C-TIRADS scoring and classification systems were 0.861, 0.897, 0.879, and 0.900, respectively, and the AUC of the scoring system was greater than the classification system for both criteria. When the Youden index was the highest, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ACR TI-RADS scoring and classification systems were consistent, ie, they were 89.66%, 41.70%, 89.93%, and 59.00%, respectively; the sensitivity, specificity, PPV, and NPV of the C-TIRADS scoring and classification systems were also consistent, ie, they were 88.71%, 44.26%, 90.23%, 59.69%, respectively. The diagnostic efficacy between the two systems was not statistically significant.
ACR TI-RADS and C-TIRADS systems had relatively high diagnostic efficacy for elderly thyroid cancer. The diagnostic efficiency of the scoring systems of ACR TI-RADS and C-TIRADS were higher than the classification systems. In addition, the two systems had high clinical practical values, while there is still a significant risk of missed diagnosis.
比较美国放射学会（ACR）的甲状腺影像报告和数据系统（TI-RADS）与中国甲状腺影像报告和数据系统（C-TIRADS）评分及分类系统对老年甲状腺癌的诊断价值。
本研究纳入了465例年龄≥60岁、经手术病理证实为甲状腺结节的患者的512个结节。由ACR TI-RADS和C-TIRADS分类系统独立评估甲状腺结节的超声特征，并绘制受试者操作特征曲线（ROC）。估计ACR TI-RADS和C-TIRADS评分及分类系统诊断老年甲状腺结节的最佳截断值，并分析诊断效能。
甲状腺癌的ACR TI-RADS和C-TIRADS评分及分类均高于良性结节（均P<0.05）。ACR TI-RADS和C-TIRADS评分及分类系统的曲线下面积（AUC）分别为0.861、0.897、0.879和0.900，两种标准下评分系统的AUC均大于分类系统。当约登指数最高时，ACR TI-RADS评分及分类系统的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）一致，分别为89.66%、41.70%、89.93%和59.00%；C-TIRADS评分及分类系统的敏感性、特异性、PPV和NPV也一致，分别为88.71%、44.26%、90.23%、59.69%。两种系统之间的诊断效能差异无统计学意义。
ACR TI-RADS和C-TIRADS系统对老年甲状腺癌具有较高的诊断效能。ACR TI-RADS和C-TIRADS评分系统的诊断效率高于分类系统。此外，这两种系统具有较高的临床实用价值，但仍存在显著的漏诊风险。
