Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial

Abstract

Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30 % of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas Under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency.

Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

“…For these systems, diagnostic accuracy is similar, with high sensitivity and low specificity [ 31 , 32 ]. In our study, ACR TIRADS sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%; for K-TIRADS—97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for EU-TIRADS —97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively, and these results are similar to other authors’ research results [ 33 , 34 , 35 ].…”

Diagnostic Performance of ACR and Kwak TI-RADS for Benign and Malignant Thyroid Nodules: An Update Systematic Review and Meta-Analysis

“…Higher DOR values (ranging from 0 to infinity) indicated better diagnostic performance. The SROC approach is considered the best method for meta-analysis and generates paired sensitivity and specificity estimates [ 6 , 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. As the discriminatory power of a test increases, the SROC curve more closely approaches the top left corner of the receiver operating characteristic curve (ROC) space (i.e., the point where sensitivity and specificity both equal 1 (100%)) [ 56 ].…”

Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany

“…To determine the malignancy rate of hypofunctional nodules, data from a prospective multicenter study by the German TIRADS Study Group (www.tirads.de; [8,9,10,11]) were evaluated. As a part of this study, since 2012, in the practice of Duisburg and Moers, every scintigraphically hypofunctioning TN was subjected to a pathological investigationregardless of other factors such as the sonomorphological appearance or result of a potentially 99m Tc-Sestamibi scintigraphy.…”