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Pattern-based vs. score-based guidelines using ultrasound features have different strengths in risk stratification of thyroid nodules

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Abstract

Objective

To evaluate and compare the diagnostic performances between recently published pattern-based and score-based TIRADS according to the experience level of the performer.

Methods

From July 2013 to January 2019, 8657 thyroid nodules in 8364 patients that had been cytopathologically diagnosed as benign or malignant were included (mean size, 22.0 mm ± 12.1). Thyroid nodules were categorized into US-based final assessment categories and US-FNA indications of five recently published TIRADS. Radiologists performing the US examinations were divided into the experienced vs. inexperienced group. Diagnostic performances and unnecessary biopsy rates were calculated and compared between the five TIRADS, also the experienced vs. inexperienced group.

Results

Of the 8657 thyroid nodules, 6706 (77.5%) were benign and 1951 (22.5%) were malignant. Diagnostic performances for US-based final assessment categories showed higher sensitivity and NPV for EU-TIRADS (92.7% and 96.5%), while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC (89.6%, 68.0%, 86.5%, and 0.878; all p < 0.05, respectively). Diagnostic performances for US-FNA indications showed higher sensitivity and NPV for KTA/KSThR TIRADS (98.5% and 97.0%), while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC (70.3%, 46.6%, 74.5%, and 0.797; all p < 0.05, respectively). Unnecessary biopsy rates were the lowest in Kwak-TIRADS for both US categories and US-FNA indications (32.0% and 53.4%, p < 0.001). Similar trends were seen in both the experienced and inexperienced group.

Conclusion

The currently published score-based guidelines for thyroid nodules have significantly higher specificity, PPV, accuracy, and AUC and lower unnecessary biopsy rates, whereas pattern-based guidelines have higher sensitivity and NPV, regardless of the level of experience of the performer.

Key Points

• For US-based final assessment categories, EU-TIRADS had higher sensitivity and NPV, while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC.

• For US-FNA indications, KTA/KSThR TIRADS had higher sensitivity and NPV, while Kwak-TIRADS had higher specificity, PPV, accuracy, and AUC.

• Similar trends were seen in diagnostic performances for both experienced and inexperienced groups.

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Abbreviations

2015 ATA:

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

ACR TI-RADS:

American College of Radiology Thyroid Imaging Reporting and Data System

AUC:

Area under the receiving operator characteristics curve

EU-TIRADS:

European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults

FNA:

Fine-needle aspiration

KTA/KSThR TIRADS:

Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Kwak-TIRADS:

TIRADS developed by Kwak et al

NPV:

Negative predictive value

PPV:

Positive predictive value

TIRADS:

Thyroid Imaging Reporting And Data System

US:

Ultrasonography

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea

    Jung Hyun Yoon, Eun-Kyung Kim, Hee Jung Moon, Vivian Youngjean Park & ** Young Kwak

  2. Biostatistics Collaboration Unit, Yonsei University, College of Medicine, Seoul, South Korea

    Hye Sun Lee

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  1. Jung Hyun Yoon
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  5. Vivian Youngjean Park
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  6. ** Young Kwak
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Correspondence to ** Young Kwak.

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The scientific guarantor of this publication is ** Young Kwak.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Hye Sun Lee, PhD, a biostatistician has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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• diagnostic or prognostic study/observational/experimental

• performed at one institution

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Yoon, J.H., Lee, H.S., Kim, EK. et al. Pattern-based vs. score-based guidelines using ultrasound features have different strengths in risk stratification of thyroid nodules. Eur Radiol 30, 3793–3802 (2020). https://doi.org/10.1007/s00330-020-06722-y

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  • DOI: https://doi.org/10.1007/s00330-020-06722-y

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