Lu Ke, Wang Long, Lai Shuiqing, Chen Zhijiang, Zhu Qibo, Cong Shuzhen, Gan Kehong, Chen Xiaoyan, Huang Chunwang, Kuang Jian
Endocr Connect. 2025 Mar 26;14(5). doi: 10.1530/EC-25-0097. Print 2025 May 1.
Current Thyroid Imaging Reporting and Data Systems (TIRADS) exhibit considerable variability in size thresholds for fine-needle aspiration biopsy. This study harnesses the systematic variations among dissimilar TIRADS optimization strategies for biopsy selection.
The analysis focused on the discrepancies observed among the four widely utilized TIRADS systems: ACR-TIRADS, Kwak-TIRADS, C-TIRADS and EU-TIRADS. Subsequently, several methods derived from the combination of two TIRADS were constructed via serial testing. Last but not least, diagnostic performance was assessed through unnecessary biopsy rate (UBR), missed malignancy rate and the frequency of clinically significant missed diagnoses.
A total of 699 nodules were included in the study. The accuracy for nodules consistently recommended for biopsy by the four TIRADS was merely 50.8%. Without elevating the risk of missed diagnoses, which could potentially influence prognosis as per the current literature, for eligible nodules recommended for biopsy by original TIRADS, incorporating another TIRADS in serial could further reduce the number of biopsies by 7.8-19.2%.
Conspicuous disparities exist in biopsy guidelines among TIRADS systems, urging increased caution among healthcare providers, particularly when they are extensively applied in patient evaluations. As evidently demonstrated by our research findings, combining recommendations from two TIRADS systems could effectively and safely lessen UBRs. These findings also advocate for the integration of prognostic-impact assessment in developing novel biopsy optimization strategies.
当前的甲状腺影像报告和数据系统（TIRADS）在细针穿刺活检的大小阈值方面存在相当大的差异。本研究利用不同TIRADS活检选择优化策略之间的系统差异。
分析聚焦于四种广泛使用的TIRADS系统（美国放射学会TIRADS、Kwak-TIRADS、中国TIRADS和欧洲TIRADS）之间观察到的差异。随后，通过系列测试构建了几种源自两种TIRADS组合的方法。最后，通过不必要活检率（UBR）、漏诊恶性肿瘤率和临床显著漏诊频率评估诊断性能。
本研究共纳入699个结节。四种TIRADS一直推荐进行活检的结节准确率仅为50.8%。对于原始TIRADS推荐进行活检的合格结节，在不增加可能影响预后的漏诊风险（根据当前文献）的情况下，依次纳入另一种TIRADS可进一步减少7.8%-19.2%的活检数量。
TIRADS系统之间的活检指南存在明显差异，这促使医疗服务提供者更加谨慎，尤其是在它们广泛应用于患者评估时。正如我们的研究结果明显表明的那样，结合两种TIRADS系统的建议可以有效且安全地降低不必要活检率。这些发现还提倡在制定新的活检优化策略时纳入预后影响评估。
