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Accuracy of thyroid imaging reporting and data system category 4 or 5 for diagnosing malignancy: a systematic review and meta-analysis

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Abstract

Objectives

To determine the accuracies of the American College of Radiology (ACR)–thyroid imaging reporting and data systems (TIRADS), Korean (K)-TIRADS, and European (EU)-TIRADS for diagnosing malignancy in thyroid nodules.

Methods

Original studies reporting the diagnostic accuracy of TIRADS for determining malignancy on ultrasound were identified in MEDLINE and EMBASE up to June 23, 2019. The meta-analytic summary sensitivity and specificity were obtained for TIRADS category 5 (TR-5) and category 4 or 5 (TR-4/5), using a bivariate random effects model. To explore study heterogeneity, meta-regression analyses were performed.

Results

Of the 34 eligible articles (37,585 nodules), 25 used ACR-TIRADS, 12 used K-TIRADS, and seven used EU-TIRADS. For TR-5, the meta-analytic sensitivity was highest for EU-TIRADS (78% [95% confidence interval, 64–88%]), followed by ACR-TIRADS (70% [61–79%]) and K-TIRADS (64% [58–70%]), although the differences were not significant. K-TIRADS showed the highest meta-analytic specificity (93% [91–95%]), which was similar to ACR-TIRADS (89% [85–92%]) and EU-TIRADS (89% [77–95%]). For TR-4/5, all three TIRADS systems had sensitivities higher than 90%. K-TIRADS had the highest specificity (61% [50–72%]), followed by ACR-TIRADS (49% [43–56%]) and EU-TIRADS (48% [35–62%]), although the differences were not significant. Considerable threshold effects were noted with ACR- and K-TIRADS (p ≤ 0.01), with subject enrollment, country of origin, experience level of reviewer, number of patients, and clarity of blinding in review being the main causes of heterogeneity (p ≤ 0.05).

Conclusions

There was no significant difference among these three international TIRADS, but the trend toward higher sensitivity with EU-TIRADS and higher specificity with K-TIRADS.

Key Points

• For TIRADS category 5, the meta-analytic sensitivity was highest for the EU-TIRADS, followed by the ACR-TIRADS and the K-TIRADS, although the differences were not significant.

• For TIRADS category 5, K-TIRADS showed the highest meta-analytic specificity, which was similar to ACR-TIRADS and EU-TIRADS.

• Considerable threshold effects were noted with ACR- and K-TIRADS, with subject enrollment, country of origin, experience level of reviewer, number of patients, and clarity of blinding in review being the main causes of heterogeneity.

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Abbreviations

ACR:

American College of Radiology

CI:

Confidence interval

ETA:

European Thyroid Association

EU:

European

FNA:

Fine-needle aspiration

HSROC:

Hierarchical summary receiver operating characteristic

K:

Korean

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

TIRADS:

Thyroid imaging reporting and data system

US:

Ultrasound

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (grant number NRF-2019R1G1A1099743).

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Author notes

  1. Dong Hwan Kim and Sae Rom Chung contributed equally to this study as co-first authors.

Authors and Affiliations

  1. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Dong Hwan Kim

  2. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Sae Rom Chung, Sang Hyun Choi & Kyung Won Kim

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  1. Dong Hwan Kim
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Correspondence to Sang Hyun Choi.

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The scientific guarantor of this publication is Sang Hyun Choi.

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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.

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One of the authors (Sang Hyun Choi) has significant statistical expertise.

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Written informed consent was not required for this study because this study was meta-analysis.

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Kim, D.H., Chung, S.R., Choi, S.H. et al. Accuracy of thyroid imaging reporting and data system category 4 or 5 for diagnosing malignancy: a systematic review and meta-analysis. Eur Radiol 30, 5611–5624 (2020). https://doi.org/10.1007/s00330-020-06875-w

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  • DOI: https://doi.org/10.1007/s00330-020-06875-w

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