Background Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules (C-TIRADS) are developed by Superficial Organ and Vascular Ultrasound Group of Ultrasound Medical Society of Chinese Medical Association in 2020. As the guideline is the latest version in China, there are few reports about its clinical application.
Objective To evaluate the diagnostic value of C-TIRADS classification for papillary thyroid carcinoma.
Methods A total of 450 patients with benign thyroid nodule (n=225) or papillary carcinoma (n=225) who underwent surgical resection verified by pathology examination in the 909 Hospital of the Joint Logistic Support Force from January 2017 to June 2021 were selected and divided into benign thyroid nodule group (BTN) and papillary thyroid carcinoma group (PTC). The sonographic characteristics of thyroid nodule and C-TIRADS classification of thyroid nodule in the two groups were reviewed and compared with pathological results. ROC curve was constructed to evaluate the diagnostic efficacy of this classification method for papillary thyroid carcinoma.
Results The proportion of women in the PTC group was significantly higher than that in the BTN group (78.22% 176/225 vs 69.33% 156/225, P=0.032). The age of the PTC group was significantly younger than that of the BTN group (46 36-54 years vs 50 44-58 years, P<0.001. The proportion of single nodules in the PTC group was significantly higher than that in the BTN group (60.44% 136/225 vs 39.11% 88/225, P<0.001). BTN was more common on both sides (45.78% 103/225), while PTC was more common on the right side (46.67% 105/225). The proportion of solid (96.01% vs 36.04%), borderline blurred/irregular or extra-thyroid invasion (71.38% vs 9.31%), vertical position (40.22% vs 2.10%), extremely hypoechoic (8.70% vs 0.60%) and microcalcification (65.22% vs 6.31%) in the PTC group was significantly higher than that in the BTN group (all P<0.001). The malignant rates of C-TIRADS were 0 for C-TR2, 2.19% for C-TR3, 16.35% for C-TR4a, 57.32% for C-TR4b, 95.71% for C-TR4c, 100% for C-TR5. The proportion of 4a, 4b, 4c and 5 in the PTC group was significantly higher than that in the BTN group, while the proportion of 2 and 3 in the PTC group was significantly lower than that in the BTN group (P<0.001). The area under ROC curve of C-TIRADS for the classification and diagnosis of papillary thyroid carcinoma was 0.937 and the optimal cut-off value corresponding to the maximum of Youden index was 4b for C-TIRADS. Its sensitivity, specificity, and accuracy were 0.924 (255/276), 0.868 (289/333), 0.893 (544/609), respectively.
Conclusion C-TIRADS classification has higher diagnostic efficiency for papillary thyroid carcinoma, and the definition of negative and positive indicators is clearer, which is less affected by the clinical experience of sonographers, and has high clinical application value.
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