C-TIRADS

Guidelines for grading thyroid nodules in China

Intensive reading and efficiency comparison

With the arrival of the 14th thyroid international publicity week, Xiaobian also wants to review the domestic ultrasonic medical field. In 2020, the Chinese Medical Association and endocrine successively published the "2020 guide for ultrasonic risk stratification of thyroid nodules". This guide announced the Chinese tirads (c-tirads) thyroid imaging reporting and data system Establishment of. This has also become an epitome of China's rapid improvement of its guide making ability and its rising research ability. C-tirads is d on the rigorous multi center statistical analysis of 2141 cases of Chinese thyroid and breast ultrasound artificial intelligence alliance. Statisticians participated in the whole process of formulation, ensuring the reliability of statistical results.

In addition to c-tirads, there are currently common thyroid risk stratification guidelines in the world. In 2009, Chilean scholars took the lead in designing a system to judge the malignant risk stratification of thyroid nodules with reference to the breast imaging reporting and data system (BIRADS) developed by the AmericanCollege of Radiology (ACR), It is called thyroid imaging reporting and data system (tirads). In 2016, Korean tirads (k-tirads) was released by the Korean Radiological Society and the Korean thyroid Radiological Society, which is the first tirads released in the name of the society in the world; In 2017, the European Thyroid Association (ETA) released the European version of EU tirads; In 2017, ACR released the acr-tirads classification.

Comparison of effectiveness of guidelines

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At present, there are six independent third-party studies comparing the diagnostic efficacy of c-tirads with other risk stratification. Except one, the others show that the diagnostic efficacy of c-tirads is better than other guidelines.

Journal: Frontiers in endocrinology, article 763897

Conclusion: c-tirads is slightly better than Kwak irads, k-tirads and acr-tirads, and significantly better than eu-tirads.

Magazine: quant imaging Med Surg 2021; 11(8):3604-3618

Conclusion: c-tirads is the best, ATA, acr-tirads and k-tirads have similar efficacy.

Journal: Chinese Journal of ultrasound imaging, Issue 9, 2021. Ultrasound malignant stratification of thyroid nodules; Comparative study of c-tirads, acr-tirads and eu-tirads.

Conclusion: the AUC of c-tirads is significantly higher than that of acr-tirads and eu-tirads (both p<0.001)

Journal: Chinese Journal of ultrasound medicine, Issue 9, 2021. Comparative study on diagnostic efficacy of c-tirads and acr-tirads in thyroid nodules

Conclusion: in the diagnosis of thyroid nodules, c-tirads guide has higher specificity and ACR ti-rads has higher sensitivity.

Journal: Chinese Journal of ultrasound imaging, 10 issues in 2020. Comparative study on diagnostic efficacy of c-tirads and acr-tirads in malignant stratification of thyroid nodules.

Conclusion: the results of c-tirads and act-tirads are the same, and both of them have good diagnostic efficacy in the hierarchical evaluation of malignant risk of thyroid nodules.

Journal: Chinese Journal of health management, issue 3, 2022. Comparative analysis of the diagnostic efficacy of c-tirads and acr-tirads in thyroid nodules.

Conclusion: c-tirads classification d on counting method is more effective than acr-tirads classification d on scoring method in the diagnosis of thyroid nodules, and is more suitable for the current situation of diagnosis and treatment of thyroid nodules in China.

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C-tirads guide ultrasound

Classification system and treatment suggestions

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one

Ultrasonic classification system of thyroid nodules

d on 2411 thyroid nodules confirmed by surgery and pathology provided by the China thyroid and breast ultrasound artificial intelligence alliance, the expert committee conducted a multivariate logistic regression analysis of the above nine gray-scale ultrasound features except size. The results showed that the location, sound halo, echo texture and posterior echo characteristics had no diagnostic value, while the solid, microcalcification, very low echo, blurred edge, irregular edge or extrathyroid invasion and vertical position were the ultrasonic characteristics of malignant nodules, and the comet tail artifact was the ultrasonic characteristics of benign nodes [11]. Count the number of the above malignant ultrasonic features, and count 1 point for each malignant ultrasonic feature. If the patient has comet tail artifacts that reflect benign features, subtract 1 point, and classify the risk of nodules according to the final total score (see Table 1).

two

Suggestions on the treatment of thyroid nodules

C-tirads class 1 does not need to deal with nodule related problems.

C-tirads class 2: (malignant probability is 0): FNAB is not required. If it is a cystic nodule, when the nodule is too large, resulting in compression symptoms or cosmetic problems, ultrasound-guided cystic fluid aspiration and chemical ablation can be performed; In case of symptoms caused by cystic solid nodules or problems affecting beauty, surgery can be selected, or when the nodules are confirmed to be benign by biopsy, ultrasound-guided thermal ablation or tumor reduction can be performed.

C-tirads class 3 (malignant probability <2%): FNAB is not required. If the nodule is too large, leading to compression symptoms or cosmetic problems, on the premise that the biopsy proves to be benign, refer to the treatment principles of class 2 nodules.

C-tirads 4a (malignant probability 2%~10%): if the maximum diameter of the nodule is >15 mm, it is recommended to ultrasound-guided FNAB; If it is a multifocal 4A nodule, or it is adjacent to the thyroid capsule, trachea, recurrent laryngeal nerve, and the maximum diameter of the nodule is >10 mm, FNAB can be considered under ultrasound guidance; For single focus nodules with maximum diameter ≤ 10 mm, if they are not adjacent to thyroid capsule, trachea or recurrent laryngeal nerve, follow-up can be selected. If the nodule is too large, leading to compression symptoms or cosmetic problems, on the premise that the biopsy proves to be benign, refer to the treatment suggestions for class 2 nodules (because class 3 refers to class 2, class 4 refers to class 3, and in essence, class 2).

C-tirads 4B (malignant probability 10%~50%), if the maximum diameter of the nodule >10 mm, it is recommended to FNAB under ultrasound guidance; If the nodule is adjacent to thyroid capsule, trachea, recurrent laryngeal nerve, or multifocal type 4B nodule, FNAB can be considered under ultrasound guidance when the maximum diameter of the nodule is >5 mm; For a single focal nodule with a maximum diameter ≤ 10 mm, if the nodule is not adjacent to the capsule, trachea or recurrent laryngeal nerve, an active monitoring strategy can be selected with the full informed consent of the patient.

C-tirads 4C (malignant probability 50%~90%): the recommended treatment is the same as that of 4B nodules.

C-tirads category 5 (malignant probability >90%): the treatment recommendations are the same as those of category 4B nodules.

C-tirads category 6 (nodules confirmed as Bethesda VI by FNAB; nodules confirmed as malignant by coarse needle aspiration biopsy): different treatment strategies such as surgery, thermal ablation or active monitoring can be selected according to different nodule sizes and patient wishes.

Comparison of shear wave and two-dimensional image of thyroid papillary microcarcinoma

epilogue

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As the first thyroid ultrasound guide in Chinese ultrasound medicine, c-tirads guide is d on large sample ultrasound data and has very high classification reliability; C-tirads classification is simple and easy to popularize; C-tirads guidelines closely follow the new concept of thyroid nodule diagnosis and treatment, and take full account of China's national conditions. Of course, as a new risk stratification system, c-tirads guideline classification still needs to find its advantages and disadvantages in clinical promotion and application for subsequent revision.

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reference

Zhou Jianqiao, Zhan Weiwei Interpretation of guidelines for the 2020 China ultrasound thyroid imaging report and data system (c-tirads) [j] Diagnostics theory and practice, 2020,19 (4): 350-353 DOI:10.16150/j.1671-2870.2020.04.005。

Qi Qi et al., Frontiers in endocrinology, article 763897 explore the diagnostic efficiency of Chinese thymoid imaging reporting and data systems by comparing with the other four systems (ACR Ti rads, Kwak tirads, ksthr tirads.And EU tirads): a single center study.

Hui Zhu et al., quant imaging Med Surg 2021; 11(8):3604-3618。 Diagnostic performance of US-d FNAB criteria of the 2020 Chinese guideline for malignant thyroid nodules； comparison with the 2017 American College of Radiology guideline，the 2016 American Thyroid Association guideline，and the 2016 Korean Thyroid Association guideline

Zheng Linlin, et al., Chinese Journal of ultrasound imaging, Issue 9, 2021. Ultrasound malignant stratification of thyroid nodules; Comparative study of c-tirads, acr-tirads and eu-tirads.

Ding Siyue, et al., Chinese Journal of ultrasound medicine, Issue 9, 2021. Comparative study on diagnostic efficacy of c-tirads and acr-tirads in thyroid nodules

Chen Qingfang, et al., Chinese Journal of ultrasound imaging, issue 10, 2020. Comparative study on diagnostic efficacy of c-tirads and acr-tirads in malignant stratification of thyroid nodules.

Gao Bo, et al., Chinese Journal of health management, issue 3, 2022. Comparative score of c-tirads and acr-tirads in the diagnostic efficacy of thyroid nodules