Comparison of British Thyroid Association, American College of Radiology TIRADS and artificial intelligence TIRADS with histological correlation : diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

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Watkins, Linda and O'Neill, Greg and Young, David and McArthur, Claire (2021) Comparison of British Thyroid Association, American College of Radiology TIRADS and artificial intelligence TIRADS with histological correlation : diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate. British Journal of Radiology, 94 (1123). 20201444. ISSN 0007-1285 (https://doi.org/10.1259/bjr.20201444)

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Abstract

OBJECTIVES: To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary fine needle aspiration (FNA) rates. METHODS: 218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for FNA. RESULTS: 77 (35.3%) nodules were malignant. Deeming ultrasound Grade 4-5 as test-positive and 1-2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilising BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001. CONCLUSION: BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering ultrasound Grade 4-5 as malignant and Grade 1-2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA. ADVANCES IN KNOWLEDGE: BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold-standard. Using Grade 1-2 as benign and 4-5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA.

ORCID iDs

Watkins, Linda, O'Neill, Greg, Young, David ORCID logoORCID: https://orcid.org/0000-0002-3652-0513 and McArthur, Claire;
  • Item type:Article
    ID code:76480
    Dates:
    Date
    Event
    1 July 2021
    Published
    14 May 2021
    Published Online
    29 April 2021
    Accepted
    Subjects:Medicine
    Department:Faculty of Science > Mathematics and Statistics
    Depositing user: Pure Administrator
    Date deposited:18 May 2021 12:21
    Last modified:19 Dec 2024 02:43
    URI:https://strathprints.strath.ac.uk/id/eprint/76480
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