Diagnostic performance of C-TIRADS in malignancy risk stratification of thyroid nodules: A systematic review and meta-analysis

Abstract

BackgroundChinese thyroid imaging reports and data systems (C-TIRADS) is a novel malignancy risk stratification used for thyroid nodule diagnosis and guiding thyroid fine needle aspiration (FNA). In this review, we aim to assess the performance of C-TIRADS in malignancy risk stratification of thyroid nodules.MethodsPubMed, Medline, Web of Science, Embase, CNKI, and Wanfang databases were searched until 1 April 2022. Original articles reporting data about C-TIRADS and setting FNA or histology as reference standards were included. C-TIRADS 4A, 4B, and 4C were set as thresholds, respectively, to obtain pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and the area under the curve (AUC). Integrated nested Laplace approximation was used for Bayesian bivariate meta-analysis of diagnostic tests.ResultsSixteen studies were included, evaluating 11,506 thyroid nodules. The rate of malignancy in each risk classification is comparable with that in C-TIRADS. C-TIRADS 4B appeared to have better diagnostic performance than C-TIRADS 4A and 4C. The pooled sensitivity, specificity, LR+, LR-, and DOR of C-TI-RADS 4B were 0.94 (95% CI: 0.89–0.97), 0.70 (95% CI: 0.60–0.79), 3.20 (95% CI: 2.28–4.39), 0.09 (95% CI: 0.05–0.15), and 33.71 (95% CI: 25.51–42.40), respectively. The area under the summary ROC curve was 0.94 (95% CI: 0.90-0.96).ConclusionC-TIRADS performed well in malignancy risk stratification of thyroid nodules. C-TIRADS 4B showed strong evidence of detecting malignancy.

Comparison of Diagnostic Values of ACR TI-RADS versus C-TIRADS Scoring and Classification Systems for the Elderly Thyroid Cancers

“… 8 In the study by Qi et al, 22 who did not stratify groups by age, the AUC of ACR TI-RADS and C-TIRADS classification systems for diagnosing malignant thyroid nodules were 0.937 and 0.854, respectively, which is in agreement with the AUC of this study, indicating that the diagnostic efficacies of the ACR TI-RADS and C-TIRADS classification systems for elderly thyroid cancer might not be affected by age. The best cut-off value of the ACR TI-RADS and C-TIRADS score were >6 and >4 points, and the best cut-off value of the classification was > TR 4 and C-TR 4B, respectively, which was in agreement with the findings reported by Kang et al and Hu et al 23 , 24 However, in the course of clinical practice, taking ACR TI-RADS >4 and C-TIRADS>4B as the optimal threshold will lead to the missed diagnosis of some cases. Especially for patients who require organ transplantation, thyroid nodules in potential organ donors need to be investigated to rule out cancer and avert any subsequent risk of transmission.…”

Thyroid collision tumour with pulmonary metastases treated effectively with nedaplatin and paclitaxel chemotherapy: A case report

“…A mixed hypoechoic heterogeneous nodule was detected in the upper middle lobe of the left thyroid (Chinese thyroid imaging reports and data systems [C-TIRADS]-4C). 10 An intense hypoechoic nodule with an unclear boundary was observed in the lower part of the right lobe, (size approximately 1.3 × 1.0 cm); it was extremely hyperechoic, with a rear acoustic shadow, and was graded C-TIRADS 4C ( Figure 1 ).…”

Efficacy analysis between ultrasound and cytology criteria in the differentiation of malignant and benign thyroid nodules: TIRADS versus BETHESDA

“…Guidelines for classifying cytology results and identifying USG features suspected of malignancy of nodules provide more accurate management of follow-up and treatment of TNs (9). The thyroid imaging report and data system (TIRADS), published by the American Society of Radiology for managing patients with nodules by USG, determine the cancer risk based on USG findings and nodule size (10). This defines TNs management according to USG characteristics, scored between 1 and 5 levels, and aims to help decide whether fine needle aspiration (FNAB) is necessary and thus avoid unnecessary procedures (11).…”