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Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS’ size thresholds for FNA

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Abstract

Objective

To investigate the diagnostic performances and unnecessary fine-needle aspiration (FNA) rates of two point-scale based TIRADS and compare them with a modified version using the ACR TIRADS’ size thresholds.

Methods

Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. A total of 2106 thyroid nodules 10 mm or larger in size in 2084 patients with definitive cytopathologic findings were included. Ultrasonography categories were assigned according to each guideline. We applied the ACR TIRADS’ size thresholds for FNA to the Kwak TIRADS and defined it as the modified Kwak TIRADS (mKwak TIRADS). Diagnostic performances and unnecessary FNA rates were evaluated for both the original and modified guidelines.

Results

Of the original guidelines, the ACR TIRADS had higher specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant mKwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. The mKwak TIRADS also had a lower unnecessary FNA rate than the ACR TIRADS (54.8% and 56.4%, respectively). The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.

Conclusion

The modified Kwak TIRADS incorporating the size thresholds of the ACR TIRADS showed higher diagnostic performance and a lower unnecessary FNA rate than the original point-scale based TIRADS.

Key Points

• Of the original guidelines, the ACR TIRADS had the highest specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively).

• When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant modified version of Kwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS.

• The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.

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Abbreviations

ACR:

American College of Radiology

FNA:

Fine-needle aspiration

TIRADS:

Thyroid Imaging Reporting and Data System

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea

    Sun Huh

  2. Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea

    Jung Hyun Yoon, Hee Jung Moon, Vivian Youngjean Park & Jin Young Kwak

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea

    Hye Sun Lee

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  1. Sun Huh
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Correspondence to Jin Young Kwak.

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The scientific guarantor of this publication is Jin Young Kwak.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

• observational

• performed at one institution

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Huh, S., Yoon, J.H., Lee, H.S. et al. Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS’ size thresholds for FNA. Eur Radiol 31, 5243–5250 (2021). https://doi.org/10.1007/s00330-020-07591-1

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  • DOI: https://doi.org/10.1007/s00330-020-07591-1

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