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Abstract：
Background Many different risk stratification systems have been formulated for thyroid nodules, differing in their fine-needle aspiration cytology (FNAC) indication, suggesting a lack of consensus around the world. Purpose This prospective study was conducted to find the best guideline for risk stratification, for a better malignancy yield, and with reduced rates of negative FNACs among three Thyroid Imaging, Reporting, and Data System (TIRADS) guidelines. Materials and Methods A total of 625 thyroid nodules with conclusive FNAC or histopathological diagnosis were included in the study. Various sonographic parameters were recorded. They were classified into categories as per the three guidelines and compared with FNAC diagnosis. The guidelines were evaluated in terms of sensitivity, specificity, predictive values, and diagnostic accuracy. Sensitivity and specificity were compared by McNemar\'s test. Results American College of Radiology (ACR) TIRADS had the highest diagnostic accuracy (56.8%), specificity (50.75%), positive predictive value (23.92%), lowest rates of negative FNACs (76.08%), and high negative predictive value (97.84 %). Korean (K) TIRADS had the maximum sensitivity (97.75%), highest negative predictive value (98.44%), and gross malignancy yield. European TIRADS was between the two other guidelines in most parameters with specificity like K TIRADS. Conclusion All the three guidelines are very good screening tools, with comparable high sensitivity. ACR TIRADS is better in terms of specificity and reduced rates of negative FNACs. Including the presence of a suspicious cervical lymph node as a criterion and more frequent follow-up might further improve the diagnostic performance of the guideline.
摘要：
背景已经为甲状腺结节制定了许多不同的风险分层系统，他们的细针穿刺细胞学（FNAC）适应症不同，表明世界各地缺乏共识。目的这项前瞻性研究是为了找到风险分层的最佳指南，为了更好的恶性肿瘤产量，在三种甲状腺成像中，FNAC阴性率降低，报告,和数据系统（TIRADS）指南。材料与方法本研究共纳入625个具有决定性FNAC或组织病理学诊断的甲状腺结节。记录各种超声参数。根据三个指南将它们分类，并与FNAC诊断进行比较。对指南的敏感性进行了评估，特异性，预测值，和诊断的准确性。通过McNemar检验比较敏感性和特异性。结果美国放射学会(ACR)TIRADS的诊断准确率最高(56.8%),特异性（50.75%），阳性预测值（23.92%），FNAC阴性率最低(76.08%)，阴性预测值高(97.84%)。韩国（K）TIRADS具有最大灵敏度（97.75％），阴性预测值最高(98.44%)，和恶性程度。欧洲TIRADS在大多数具有特异性的参数（如KTIRADS）中位于其他两个指南之间。结论三个指南都是很好的筛选工具,具有相当高的灵敏度。ACRTIRADS在特异性和减少阴性FNAC的比率方面更好。将可疑颈淋巴结的存在作为标准并进行更频繁的随访可能会进一步提高指南的诊断性能。
