Huang Ge-Lang, Su Jing-Yan, Liang Rui-Qiao, Yang Xi-Yue, Xu Li-Fang
Department of Rehabilitation, Guigang Peoples's Hospital, Guigang, Guangxi Zhuang Autonomous Region, People's Republic of China.
Department of Radiology, Guangxi Zhuang Autonomous Region Corps Hospital of Chinese People's Armed Police Force, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.
Int J Gen Med. 2025 Sep 15;18:5509-5517. doi: 10.2147/IJGM.S541530. eCollection 2025.
To investigate whether echogenicity grading can improve the diagnostic performance of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS).
Ultrasonic (US) images of 646 thyroid nodules (TNs) were retrospectively reviewed. The sonographic features of each nodule were analyzed and noted, including the orientation, margin, composition, echogenicity, echogenic foci, and extrathyroidal extension. Hypoechoic was further graded as mildly, moderately and markedly hypoechoic, and the malignancy risk at different echogenicity levels was compared. Each nodule was categorized according to C-TIRADS using markedly hypoechoic, modified markedly hypoechoic, and hypoechoic as malignant indicators, and the classification results were recorded as TI-RADS 1, 2, and 3, respectively. The diagnostic sensitivity, specificity, and area under the curve (AUC) of the different echogenicity and TIRADS were compared using chi-square analysis and Receiver Operating Characteristic curves (ROC). Binary logistic regression analysis was used to calculate cancer risk for different echogenicity. The interobserver agreement in the grading of echogenic of the nodules was also assessed.
Most malignant nodules were hypoechoic (85.2%), and the malignancy risk of hypoechoic nodules was significantly higher than that of iso-hyperechoic nodules (34.4% vs 9.8%). The malignancy risk gradually increased as nodule echogenicity decreased (odd ratios (ORs) of 2.132, 10.009, and 15.006, respectively). There was no significant difference in the malignancy risk between moderately and markedly hypoechoic nodules (=0.203). The modified markedly hypoechoic region showed the highest AUC and the most balanced sensitivity and specificity for the diagnosis of thyroid cancer. The diagnostic performance of TI-RADS 2 was significantly higher than that of TI-RADS 1 and 3 (AUC of 0.715, 0.608, and 0.656, respectively). Substantial agreement was obtained between the two observers in grading markedly hypoechoic and modified markedly hypoechoic (κ = 0.79 and 0.75; 95% CI: 0.75,0.83 and 0.64,0.86).
Stratifying hypoechogenic to three degrees enhances confidence in evaluating malignancy risk. Compared to markedly hypoechoic, the modified markedly hypoechoic significantly boosted the ability of C-TIRADS to differentiate benign TNs from malignant ones.
探讨回声分级能否提高中国甲状腺影像报告和数据系统（C-TIRADS）的诊断性能。
回顾性分析646个甲状腺结节（TN）的超声（US）图像。分析并记录每个结节的超声特征，包括方位、边界、成分、回声、回声灶及甲状腺外延伸情况。将低回声进一步分为轻度、中度和显著低回声，并比较不同回声水平下的恶性风险。根据C-TIRADS将每个结节分别以显著低回声、改良显著低回声和低回声作为恶性指标进行分类，分类结果分别记录为TI-RADS 1、2和3。采用卡方分析和受试者工作特征曲线（ROC）比较不同回声及TIRADS的诊断敏感性、特异性和曲线下面积（AUC）。采用二元逻辑回归分析计算不同回声的癌症风险。同时评估两位观察者对结节回声分级的一致性。
大多数恶性结节为低回声（85.2%），低回声结节的恶性风险显著高于等回声-高回声结节（34.4%对9.8%）。随着结节回声降低，恶性风险逐渐增加（优势比分别为2.132、10.009和15.006）。中度和显著低回声结节的恶性风险无显著差异（P = 0.203）。改良显著低回声区域对甲状腺癌诊断的AUC最高，敏感性和特异性最平衡。TI-RADS 2的诊断性能显著高于TI-RADS 1和3（AUC分别为0.715、0.608和0.656）。两位观察者在显著低回声和改良显著低回声分级上具有高度一致性（κ = 0.79和0.75；95%可信区间：0.75,0.83和0.64,0.86）。
将低回声分为三个等级可增强评估恶性风险的信心。与显著低回声相比，改良显著低回声显著提高了C-TIRADS区分良性TN和恶性TN的能力。
