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

Authors
 Jung Hyun Yoon  ;  Hye Sun Lee  ;  Eun-Kyung Kim  ;  Hee Jung Moon  ;  Vivian Youngjean Park  ;  Jin Young Kwak 
Citation
 EUROPEAN RADIOLOGY, Vol.30(7) : 3793-3802, 2020-07 
Journal Title
 EUROPEAN RADIOLOGY 
ISSN
 0938-7994 
Issue Date
2020-07
Keywords
Fine-needle aspiration ; Neoplasm ; Thyroid ; Thyroid Imaging Reporting And Data System ; Ultrasonography
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.
Full Text
https://link.springer.com/article/10.1007%2Fs00330-020-06722-y
DOI
10.1007/s00330-020-06722-y
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Park, Vivian Youngjean(박영진) ORCID logo https://orcid.org/0000-0002-5135-4058
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179553
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