Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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A Multicenter Prospective Validation Study for the Korean Thyroid Imaging Reporting and Data System in Patients with Thyroid Nodules

  • Ha, Eun Ju (Department of Radiology, Ajou University School of Medicine) ;
  • Moon, Won-Jin (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Na, Dong Gyu (Department of Radiology, Human Medical Imaging and Intervention Center) ;
  • Lee, Young Hen (Department of Radiology, Ansan Hospital, Korea University School of Medicine) ;
  • Choi, Nami (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Soo Jin (Department of Radiology, Human Medical Imaging and Intervention Center) ;
  • Kim, Jae Kyun (Department of Radiology, Chung-Ang University Hospital)
  • Received : 2016.05.06
  • Accepted : 2016.06.15
  • Published : 2016.09.01
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Abstract

Objective: To validate a new risk stratification system for thyroid nodules, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), using a prospective design. Materials and Methods: From June 2013 to May 2015, 902 thyroid nodules were enrolled from four institutions. The type and predictive value of ultrasonography (US) predictors were analyzed according to the combination of the solidity and echogenicity of nodules; in addition, we determined malignancy risk and diagnostic performance for each category of K-TIRADS, and compared the efficacy of fine-needle aspiration (FNA) with a three-tier risk categorization system published in 2011. Results: The malignancy risk was significantly higher in solid hypoechoic nodules, as compared to partially cystic or isohyperechoic nodules (each p < 0.001). The presence of any suspicious US features had a significantly higher malignancy risk (73.4%) in solid hypoechoic nodules than in partially cystic or isohyperechoic nodules (4.3-38.5%; p < 0.001). The calculated malignancy risk in K-TIRADS categories 5, 4, 3, and 2 nodules were 73.4, 19.0, 3.5, and 0.0%, respectively; and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy were 95.5, 58.6, 44.5, 96.9, and 69.5%, respectively, in K-TIRADS categories 4 and 5. The efficacy of FNA for detecting malignancy based on K-TIRADS was increased from 18.6% (101/544) to 22.5% (101/449), as compared with the three-tier risk categorization system (p < 0.001). Conclusion: The proposed new risk stratification system based on solidity and echogenicity was useful for risk stratification of thyroid nodules and the decision for FNA. The malignancy risk of K-TIRADS was in agreement with the findings of a previous retrospective study.

Keywords

References

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