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KMID : 0880420210220091579
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Korean Journal of Radiology
2021 Volume.22 No. 9 p.1579 ~ p.1586
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Diagnostic Performance of the Modified Korean Thyroid Imaging Reporting and Data System for Thyroid Malignancy: A Multicenter Validation Study
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Chung Sae-Rom
Ahn Hye-Shin
Choi Young-Jun
Lee Ji-Ye
Yoo Roh-Eul
Lee Yoo-Jin
Kim Jee-Young
Sung Jin-Yong
Kim Ji-Hoon
Baek Jung-Hwan
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Abstract
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Objective: To evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS), and compare it with the 2016 version of K-TIRADS using the Thyroid Imaging Network of Korea.
Materials and Methods: Between June and September 2015, 5708 thyroid nodules (≥ 1.0 cm) from 5081 consecutive patients who had undergone thyroid ultrasonography at 26 institutions were retrospectively evaluated. We used a biopsy size threshold of 2 cm for K-TIRADS 3 and 1 cm for K-TIRADS 4 (modified K-TIRADS 1) or 1.5 cm for K-TIRADS 4 (modified K-TIRADS 3). The modified K-TIRADS 2 subcategorized the K-TIRADS 4 into 4A and 4B, and the cutoff sizes for the biopsies were defined as 1 cm for K-TIRADS 4B and 1.5 cm for K-TIRADS 4A. The diagnostic performance and the rate of unnecessary biopsies of the modified K-TIRADS for detecting malignancy were compared with those of the 2016 K-TIRAD, which were stratified by nodule size (with a threshold of 2 cm).
Results: A total of 1111 malignant nodules and 4597 benign nodules were included. The sensitivity, specificity, and unnecessary biopsy rate of the benign nodules were 94.9%, 24.4%, and 60.9% for the 2016 K-TIRADS; 91.0%, 39.7%, and 48.6% for the modified K-TIRADS 1; 84.9%, 45.9%, and 43.5% for the modified K-TIRADS 2; and 76.1%, 50.2%, and 40.1% for the modified K-TIRADS 3. For small nodules (1?2 cm), the diagnostic sensitivity of the modified K-TIRADS decreased by 5.2?25.6% and the rate of unnecessary biopsies reduced by 19.2?32.8% compared with those of the 2016 K-TIRADS (p < 0.001). For large nodules (> 2 cm), the modified K-TIRADSs maintained a very high sensitivity for detecting malignancy (98%).
Conclusion: The modified K-TIRADSs significantly reduced the rate of unnecessary biopsies for small (1?2 cm) nodules while maintaining a very high sensitivity for malignancy for large (> 2 cm) nodules.
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KEYWORD
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Thyroid nodule, Thyroid cancer, Diagnostic performance, Ultrasonography, Fine-needle aspiration
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