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Objective To compare diagnostic values of the 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer with the thyroid imaging reporting and data system (TI-RADS) for sonographic malignancy risk stratification of thyroid nodules.Methods From November 2011 to December 2015,485 thyroid nodules in 331 patients (mean age,42.9 years± 10.4)were included in this study.Characteristics includingsize,composition,shape(nonparallel or parallel),margin,echogenicity,calcifications and extrathyroidal extension of thyroid nodules were evaluated.Every nodule was stratificated by criteria set by TI-RADS and ATA guidelines,and malignant rate of each risk stratification were calculated and analysed.With pathology as the gold standard,different cutoff were taken to diagnose malignant nodules,and the sensitivity,specifity,positive predictive value,negativepredictive value and accuracy of the two methodologies were calculated at each cutoff.And the two methodologies were evaluated and measured by ROC curve.Finally their Kappa value were calculated at the best cutoff.Results Of the 485 thyroid nodules,96 were benign and 389 were malignant.The malignancy rates under TI-RADS category 2,3,4a,4b,4c,and 5 nodules were 0,12.0％ (3/25),22.2％ (10/45),29.8％ (14/47),99.2％ (261/363) and 100％ (101/101).Malignancy rates under ATA guidelines of benign,very low,low,intermediate,and high suspicion for malignancy were 0,12.5％ (1/8),16.1％ (10/62),27.7％ (13/47),and 99.2％ (365/368).There were significant differences inside each patterns (P ＜ 0.01) respectively and high correlation between risk stratification with TI-RADS (r=0.70) and ATA guidelines (r=0.83).Areas under the ROC curve of the TI-RADS and ATA guidelines classifications were 0.966 and 0.959.Best cut-off point for diagnosing malignant by TI-RADS and ATA guideline classifications were ≥ 4c and ≥ high suspicion,and at that point,diagnostic value of TI-RADS and ATA guidelines were nearly the same(sensitivity,93.1％vs 93.8％;specificity,97.9％ vs 96.9％;PPV,99.5％ vs 99.2％;NPV,75.7％vs 79.5％;and accuracy,94.0％vs94.4％),and there was no significant differences (P=0.50,P=0.50,P=0.50,P=0.53,P=0.55),Kappa=0.97.Conclusions Both TI-RADS and the ATA guidelinesprovide effective malignancy risk stratification for thyroid nodules.The diagnosticvalue of TI-RADS when considering ≥ 4c and ATA guidelines when considering ≥ high-suspicion nodules as malignant were nearly the same and both high.
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Background and purpose:This study investigated the value of cervical ultrasound and TSH-sup-pressed thyroglobulin in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma (DTC).Methods:This study analyzed the data on 196 thyroid carcinoma patients who underwent neck dissection after clinically sus-pecious recurrence of DTC in Peking Union Medical College Hospital from Aug. 2010 to Dec. 2014. Among the 196 patients, 62 patients sonographically suspecious recurrence after total thyroidectomy and/or radioactive iodine ablation therapy were enrolled in this study. The ultrasonic features of lymph node involvement were retrospectively analyzed. The value of the ultrasonic features in the diagnosis of lymph node involvement and a TSH-suppressed serum Tg level in the diagnosis of recurrence or metastasis of DTC was also evaluated.Results:Of the 62 patients, 59 were pathologi-cally conifrmed with lymph node involvement, 1 case with local recurrence and 2 cases without recurrence or metasta-sis. There were 121 ultrasonographically suspected lymph nodes, conifrmed by pathology, 92 were metastatic ltsions, 25 were non-metastatic, 3 were ifbrous tissue and 1 was striated muscle. The positive predictive rate of cyst, calciifcation or hyper-echogenicity in cortex was 100% in the diagnosis of lymph node involvement. There was a signiifcant difference in disordered vascularity and cyst in cortex between metastatic and non-metastatic lymph nodes. Forty-nine patients were positive for Tg, whereas 13 were negative. The accuracy, sensitivity and speciifcity of TSH-suppressed serum Tg in the diagnosis of recurrence or metastasis of DTC were 82.3%, 81.7% and 100%.Conclusion:The disordered vascularity and cyst in cortex of the lymph node are highly speciifc indexes in diagnosing lymph node involvement. TSH-suppressed serum Tg level has high diagnostic value for detection of recurrence or metastasis of DTC. Cervical ultrasound can identify recurrent or metastatic lesions in both Tg-positive and Tg-negative patients.