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Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines

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Abstract

Objectives

(1) To compare the American College of Radiology (ACR) thyroid imaging reporting and data system (TIRADS) and American Thyroid Association (ATA) guidelines for thyroid nodules with regard to diagnostic performance and effectiveness at reducing the number of fine-needle aspiration (FNA) biopsies and to preliminarily discuss the reasons for the differences and (2) to compare the diagnostic performance of the two guidelines in the subgroup of nodules <1 cm in diameter.

Materials and methods

In the present study, 1000 thyroid nodules in 894 consecutive patients with final diagnoses were included; these thyroid nodules were investigated via FNA biopsies in our hospital. The ultrasound (US) features of the thyroid nodules were reviewed and stratified according to the categories defined by the ACR TIRADS and ATA guidelines.

Results

Compared with the ACR TIRADS guidelines, the ATA guidelines had a higher sensitivity (93.4% (P < 0.001)) and a larger negative predictive value (NPV) (85.3% (P= 0.034)). Compared with the ATA guidelines, the ACR TIRADS guidelines had a higher specificity (66.0% (P < 0.001)), a greater PPV (73.6% (P= 0.001)), and greater accuracy (75.5% (P= 0.017)). Compared with the ATA guidelines, the ACR TIRADS guidelines resulted in significantly fewer unnecessary FNA biopsies (P= 0.007).

Conclusions

This study suggests that both the ACR TIRADS and ATA guidelines have unique strengths with regard to their diagnostic performance. In terms of reducing the number of FNA biopsies, the ACR TIRADS guidelines were superior to the ATA guidelines.

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Abbreviations

ACR:

American College of Radiology

ATA:

American Thyroid Association

FNA:

fine-needle aspiration

CNB:

core-needle biopsy

TIRADS:

thyroid imaging reporting and data system

US:

ultrasound

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Acknowledgements

This study was funded by the Finance Department of Jilin Province (no. SCZSY201701), the Jilin Provincial Health and Family Planning Commission (no. 2016ZC032), and Jilin Province Science and Technology Department (no. 20170414042GH).

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Author notes

  1. These authors contributed equally: Xiao-Li Wu, Jia-Rui Du

Authors and Affiliations

  1. Department of Ultrasound, The First Hospital of Jilin University, Changchun, 130000, Jilin, China

    Xiao-Li Wu

  2. Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China

    Jia-Rui Du, Hui Wang, Chun-Xiang Jin, Guo-Qing Sui, Dong-Yan Yang, Yuan-Qiang Lin, Qiang Luo, Ping Fu, He-Qun Li & Deng-Ke Teng

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Wu, XL., Du, JR., Wang, H. et al. Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines. Endocrine 65, 121–131 (2019). https://doi.org/10.1007/s12020-019-01886-0

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