High Risk Thyroid Nodule Discrimination and Management by Modified TI-RADS

Figures & data

Table 1 Malignant Risk of Thyroid Nodules Reported by Modified TI-RADS and Corresponding Medical Suggestion

Grade	Malignant Risk	Medical Suggestion
0	No abnormalities in ultrasound in clinically suspected cases, including additional examinations, such as for thyroiditis	No medical treatment needed
1	Normal thyroid or cystic nodules without further follow-up	Medical observation
2	Benign nodules with no obvious signs of malignancy	Re-inspection every 1–2 years
3	Nodules may be benign with malignancy risk less than or equal to 5%	Re-inspection every 6 months to 1 year, and seek medical attention once changed
4	Suspected malignancy requiring surgery or fine-needle aspiration biopsy before surgery
4a	The proportion of malignancy is 6–45%	Re-inspection within 3–6 months or consult outpatient department of head and neck surgery
4b	The proportion of malignancy is 46–75%	Re-inspection within 3 months or to visit outpatient department of head and neck surgery
4c	The proportion of malignancy is 76–95%	Visit outpatient department of head and neck surgery
5	Malignant nodules with clear lymph node metastasis	Visit outpatient department of head and neck surgery and seek further treatment
6	Malignant nodules confirmed by biopsy pathology	Conventional medical care followed surgical treatment

Figure 1 The classification standard for modified TI-RADS system. (A) Grade 0 by improved TI-RADS system; (B) Grade 1 by improved TI-RADS system; (C), Grade 2 by improved TI-RADS system; (D) Grade 3 by improved TI-RADS system; (E) Grade 4a by improved TI-RADS system; (F) Grade 4b by improved TI-RADS system; (G) Grade 4c by improved TI-RADS system; (H) Thyroid nodules, Grade 5 by improved TI-RADS system; (I and H) Lymphatic metastasis, Grade 5 by improved TI-RADS system; (J) Thyroid papillary cancer under microscope by 400×, Grade 6 by improved TI-RADS system.

Table 2 Incidence of Thyroid Nodules and Detection Rate of Thyroid Cancer Between Males and Females

Item	Male	Female	Total	χ^2	P
Thyroid nodules				52.750	*0.000
Negative	1,726	1,402	3,128
Positive	912	1,122	2,034
Detection rate (%)	34.57	44.45	39.4
High risk nodules
Negative	2603	2485	5088	0.435	0.559
Positive	35	39	74
Detection rate (%)	1.33	1.55	1.43
Thyroid cancer				0.224	0.731
Negative	2,622	2,506	5,131
Positive	16	18	34
Detection rate (%)	0.61	0.71	0.66
Total	2,638	2,524	5,162

Note: *P<0.05 is statistically significant.

Table 3 Clinical Characteristics of the Thyroid Cancer Patients

Clinical Characteristics	n
Items
Gender
Male	16
Female	18
Age (Mean±SD years old)	45.81±12.03
Tumor Character
Size
≤1	27
>1 and ≤2	7
Number
Single	28
Multiple	6
Location
Unilateral	28
Bilateral	6
Pathological type
Papillary carcinoma	33
Medullary carcinoma	1
Lymph node metastasis
No	20
Yes	14
N1a	10
N1b	4
Clinical stage
I	29
III	4
IVa	1
Risk of recurrence
Low risk group	18
Middle risk group	13
High risk group	2
Modified TI-RADS Before surgical Treatment
3	5
4a	14
4b	7
4c	6
5	2
Surgical time distribution
1st year follow-up	18
2nd year follow-up	5
3nd year follow-up	8
4th year follow-up	2
5th year follow-up	1

Figure 2 The incidence of thyroid nodules and thyroid cancer among patients (A) incidence of thyroid nodules among different age teams; (B) incidence of high risk nodules among different age teams; (C) incidence of diagnosed thyroid cancer among different age teams; (D) thyroid cancer incidence in each grade by the modified TI-RADS; (E) comparison with the average ages between the low risk group and the high risk group (P<0.001); and (F) comparison with the average age between undiagnosed and diagnosed thyroid cancer patients in the high risk group (P<0.001).

Table 4 Thyroid Nodules Detection by Ultrasonography Reported by Modified TI-RADS System During the 5-year Follow-Up

Modified TI-RADS Grades	Initial Diagnosis	1st Year	2nd Year	3rd Year	4th Year	5th Year
0	3,128	3,128	3,128	3,128	3,128	3,128
1	352	352	352	352	352	352
2	1,514	1,513	1,513	1,513	1,512	1,512
3	100	95	96	96	96	96
4
4a	48	42	41	39	39	38
4b	15	12	8	3	2	2
4c	5	1	0	0	0	0
5	0	1	1	0	0	0
6*	0	18	23	31	33	34

Note: *Grade 6: Malignant nodules confirmed by biopsy pathology.

Table 5 Thyroid Nodules Changes with Modified TI-RADS Grades During the 5 Year Follow-Up

Follow-Up Time	Modified TI-RADS Grades	n
1st year
	2 to 3	1
	2 to 4a	2
	3 to 2	1
	3 to 6*	5
	4a to 2	1
	4a to 4b	1
	4a to 4c	1
	4a to 6*	5
	4b to 4c	1
	4b to 6*	3
	4c to 5	1
	4c to 6*	5
2nd year
	2 to 3	1
	4a to 2	1
	4a to 4b	1
	4b to 4c	1
	4b to 6*	3
	4c to 5	1
	4c to 6*	1
	5 to 6*	1
3rd year
	4a to 6*	7
	5 to 6*	1
4th year
	4a to 6*	1
	4b to 6*	1
5th year
	4a to 6*	1

Notes: *Grade 6: Malignant nodules confirmed by biopsy pathology.