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Diagnostic performance of the 2021 Korean thyroid imaging reporting and data system in pediatric thyroid nodules

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Abstract

Objectives

To evaluate the diagnostic performance of 2021 K-TIRADS biopsy criteria for detecting malignant thyroid nodules in a pediatric population, making comparisons with 2016 K-TIRADS.

Methods

This retrospective study included pediatric patients with histopathologically confirmed diagnoses. The diagnostic performance of 2021 K-TIRADS was compared with that of 2016 K-TIRADS. Simulation studies were performed by changing biopsy cut-off sizes for K-TIRADS 5 to 1.0 cm (K-TIRADS5-1.0cm) and 0.5 cm (K-TIRADS5-0.5cm), and for K-TIRADS 4 to 1.0 cm (K-TIRADS4-1.0cm) and 1.0–1.5 cm (K-TIRADS4-1.0~1.5cm). Subgroup analysis was performed in small (< 1.5 cm) and large nodules (≥ 1.5 cm).

Results

Two hundred seventy-seven thyroid nodules (54.9% malignant) from 221 pediatric patients were analyzed. All simulated 2021 K-TIRADS showed higher accuracy than 2016 K-TIRADS. Compared with 2021 K-TIRADS5-1.0cm, 2021 K-TIRADS5-0.5cm showed lower specificity (51.6% vs. 47.9%; p = 0.004) but higher sensitivity (77.2% vs. 90.3%; p < 0.001) and accuracy (62.7% vs. 68.9%; p < 0.001). Compared with 2021 K-TIRADS4-1.0cm, 2021 K-TIRADS4-1.0~1.5cm showed higher specificity (44.9% vs. 47.9%; p = 0.018) without significant difference in other diagnostic measures. Compared with 2016 K-TIRADS, 2021 K-TIRADS (biopsy cut-offs, 0.5 cm for K-TIRADS 5; 1.0–1.5 cm for K-TIRADS 4) showed higher sensitivity (34.0% vs. 67.3%; p < 0.001) while maintaining specificity (89.4% vs. 88.2%; p = 0.790) in small nodules, and higher specificity (5.9% vs. 25.4%; p < 0.001) while maintaining sensitivity (100% vs. 98.7%; p = 0.132) in large nodules.

Conclusions

In pediatric patients, 2021 K-TIRADS showed superior diagnostic accuracy to 2016 K-TIRADS, especially with a biopsy cut-off of 0.5 cm for K-TIRADS 5 and 1.0–1.5 cm for K-TIRADS 4.

Key points

• All simulated 2021 K-TIRADS showed higher accuracy than 2016 K-TIRADS.

• 2021 K-TIRADS with cut-off size for K-TIRADS 5 of 0.5 cm showed lower specificity but higher sensitivity and accuracy than that of 1.0 cm.

• Compared with 2016 K-TIRADS, 2021 K-TIRADS (biopsy cut-offs, 0.5 cm for K-TIRADS 5; 1.0–1.5 cm for K-TIRADS 4) showed higher sensitivity while maintaining specificity in small nodules, and higher specificity while maintaining sensitivity in large nodules.

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Abbreviations

AUS:

Atypia of undetermined significance

CNB:

Core needle biopsy

FLUS:

Follicular lesion of undetermined significance

FNAB:

Fine needle aspiration biopsy

GEE:

Generalized estimating equation

ICC:

Intraclass correlation coefficient

K-TIRADS:

Korean Thyroid Imaging Reporting and Data System

RSS:

Risk stratification system

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

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Authors and Affiliations

  1. 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

    Pyeong Hwa Kim, Hee Mang Yoon, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee, Jin Seong Lee, Ah Young Jung & Young Ah Cho

  2. University of Ulsan Foundation for Industry Cooperation, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Boram Bak

  3. Department of Radiology, GangNeung Asan Hospital, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea

    Dong Gyu Na

  4. Department of Radiology, Human Medical Imaging and Intervention Center, 621 Gangnam-daero, Seocho-gu, Seoul, 06524, Republic of Korea

    Dong Gyu Na

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  1. Pyeong Hwa Kim
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Corresponding authors

Correspondence to Hee Mang Yoon or Jung Hwan Baek.

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Guarantor

The scientific guarantor of this publication is Jung Hwan Baek.

Conflict of interest

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

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohort overlap

Some study subjects or cohorts have been previously reported in Kim PH, Yoon HM, Baek JH, et al (2022) Diagnostic Performance of Five Adult-based US Risk Stratification Systems in Pediatric Thyroid Nodules. Radiology. DOI:10.1148/radiol.212762:212762

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Kim, P.H., Yoon, H.M., Baek, J.H. et al. Diagnostic performance of the 2021 Korean thyroid imaging reporting and data system in pediatric thyroid nodules. Eur Radiol 33, 172–180 (2023). https://doi.org/10.1007/s00330-022-09037-2

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