Differential Diagnosis of Benign and Malignant Thyroid Nodules in the Context of Hashimoto's Thyroiditis:Ultrasonic Clini-cal Application of C-TIRADS(2023 Edition)Guidelines and ACR TI-RADS

CHEN Zili; ZHOU Wan; LIANG Hao; YANG Li; DU Rui

doi:10.13730/j.issn.2097-2148.2024.11.006

Abstract：Objective To compare the efficacy of Chinese Thyroid Imaging Reporting and Data System(C-TI-RADS)(2023 edition)and American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)in the diagnosis of Hashimoto's thyroiditis with benign and malignant thyroid nodules and the consistency of the same guidelines used by doctors with different years of experience.Methods A total of 268 patients with Hashimoto's thyroid-itis with thyroid nodules who accepted surgery from June 2013 to March 2024 were retrospectively analyzed.Each nodule was graded according to C-TIRADS(2023 edition)and ACR TI-RADS by 1 junior sonographer(with 4 years of ultra-sound working experience)and 1 senior sonographer(with 15 years of ultrasound working experience),respectively,and compared with the pathological results of surgery.Malignant rate,sensitivity,specificity,accuracy and Kappa value of each classification of nodules were calculated,receiver operating characteristic(ROC)curve was drawn and area under the curve(AUC)value was compared.Results There were statistically significant differences in the malignant rates of thyroid nodules in each category(all P＜0.001).The AUC,sensitivity,specificity and accuracy of ACR TI-RADS for junior sonographer in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules were 0.837,61.97％,91.29％and 81.03％respectively.C-TIRADS(2023 editsion)were 0.869,71.83％,88.26％and 82.51％,respectively;the AUC,sensitivity,specificity and accuracy of ACR TI-RADS for senior sonographer in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules were 0.884,71.82％,93.18％and 85.71％,respectively,C-TIRADS(2023 edition)were 0.910,80.99％,89.77％and 86.70％,respectively;there were statistically significant differences in the efficacy of ACR TI-RADS and C-TIRADS(2023 edition)in the differential diagnosis of Hashimoto's thyroiditis with thyroid nodules among doctors with different years of experience(all P＜0.05).The optimal cutoff values of ACR TI-RADS and C-TIRADS(2023 edition)were cate-gory 5 and 4B,respectively.The C-TIRADS(2023 edition)and ACR TI-RADS guidelines were used by two doctors with different years of experience to evaluate the benign and malignant characteristics of Hashimoto's thyroiditis combined with thyroid nodules,and the Kappa values were 0.913 and 0.854,respectively,consistency was excellent.Conclusion The C-TIRADS(2023 edition)guideline and the ACR TI-RADS guideline are highly effective in the diagnosis of benign and malignant nodules in the context of Hashimoto's thyroiditis.The diagnostic performance of C-TIRADS(2023 edition)is better than that of ACR TI-RADS,and it is faster and more convenient to use.The application of both guidelines to nod-ules is very consistent with the application of different seniority physicians.