Comparison of Diagnostic Values of ACR TI-RADS versus C-TIRADS Scoring and Classification Systems for the Elderly Thyroid Cancers

Figures & data

Table 1 Five Ultrasonic Features and Corresponding Scores in ACR TI-RADS Classification

Composition		Echogenicity		Sharp		Margin		Echogenic Foci
Cystic or almost completely cystic,	0 points	Anechoic	0 points	Wider-than-tall	0 points	Smooth	0 points	None or large comet-tail artifacts	0 points
Spongiform	0 points	Hyperechoic or isoechoic	1 points	Taller-than-wide	3 points	Ill-defined	0 points	Macrocalcifications calcifications	1 points
Mixed cystic and solid	1 points	Hypoechoic	2 points			Lobulated or irregular	2 points	Peripheral(rim) calcifications	2 points
Solid or almost completely solid	2 points	Very hypoechoic	3 points			Extra-thyroidal extension	3 points	Punctate echogenic Foci	3 points

Table 2 The ACR TI-RADS Based on the Counting Method

Score	ACR TI-RADS Category	Malignancy Rate (%)
0	TR 1	Benign
2	TR 2	Not suspicious
3	TR 3	Mildly suspicious
4–6	TR 4	Moderately suspicious
>7	TR 5	Highly suspicious

Table 3 Ultrasonic Positive and Negative Features and Corresponding Scores

Positive features	Vertical orientation	+1
	Solid composition	+1
	Markedly hypoechoic	+1
	Microcalcification	+1
	Ill-defined/irregular margins or extrathyroidal extensions	+1
Negative features	Comet tail artifacts	−1

Table 4 The C-TIRADS Based on the Counting Method

Nodule	Score	Malignancy Rate (%)	C-TIRADS Category
Absent	NA	0	1, no nodule
Present	−1	0	2, benign
	0	<2	3, probably benign
	1	2–10	4A, low suspicion
	2	10–50	4B, moderate suspicion
	3–4	50–90	4C, high suspicion
	5	>90	5, highly suggestive of malignancy
	NA	NA	6, biopsy proved malignant

Table 5 Pathological results of the elderly thyroid nodules

Benign	n	Low-risk	n	Malignant	n
Nodular goiter	171	Follicular tumor of undetermined malignant potential	2	Papillary carcinoma	240
Follicular adenoma	20	Hurthle cell tumors of undetermined malignant potential	1	Undifferentiated carcinoma	4
Lymphocytic thyroiditis	14	Well differentiated tumors of undetermined malignant potential	1	Medullary carcinoma	4
				Lymphoma	3
				Follicular carcinoma	2
				Metastatic cancer	1

Table 6 Ultrasonic Features of Benign and Malignant Thyroid Nodules (n)

Group	Number	Composition				Echogenicity				Shape
		Cystic or Almost Completely Cystic	Spongiform	Mixed Cystic and Solid	Solid or Almost Completely Solid	Anechoic	Hyperechoic or Isoechoic	Hypoechoic	Very Hypoechoic	Wider-Than-Tall	Taller-Than-Wide
Benign	254	12	0	113	129	12	63	168	11	223	31
Malignant	258	1	0	4	253	1	5	181	71	71	187
χ2 values		151.084				103.140				176.998
P values		<0.001				<0.001				<0.001

Table 7 C-TIRADS Positive Indicators of Benign and Malignant Thyroid Nodules (n)

Group	Vertical Orientation	Solid Composition	Markedly Hypoechoic	Microcalcification	Ill-Defined/Irregular Margins or Extrathyroidal Extensions
Benign (n=254)	31	118	11	31	67
Malignant (n=258)	187	249	71	103	249
χ^2 values	190.198	157.973	51.167	50.891	266.461
P values	<0.001	<0.001	<0.001	<0.001	<0.001

Figure 1 72-year-old man with thyroid papillary carcinoma.

Figure 2 63-year-old woman with nodular goiter.

Table 8 Comparison of ACR TI-RADS versus C-TIRADS Scores of Elderly Thyroid Nodules

Group	ACR TI-RADS Score	C-TIRADS Score
Benign	4.17±2.45	1.02±1.27
Malignant	8.86±2.62	3.33±0.95
t values	20.900	23.311
P values	<0.001	<0.001

Table 9 ACR TI-RADS and C-TIRADS Classifications of Elderly Thyroid Nodules

Group	ACR TI-RADS Classification					C-TIRADS Classification
	TR 1	TR 2	TR 3	TR4	TR 5	C-TR 2	C-TR 3	C-TR 4A	C-TR 4B	C-TR 4C	C-TR 5
Benign	12	43	83	61	55	12	118	48	28	47	1
Malignant	0	1	4	22	231	0	4	6	26	202	20
χ^2 values	250.444					264.927
P values	<0.001					<0.001

Figure 3 ROC curves of ACR TI-RADS and C-TIRADS score and classification. (A) shows diagnostic efficiency of ACR TI-RADS score and classification system for the elderly thyroid cancers; (B) shows diagnostic efficiency of C-TIRADS score and classification system for the elderly thyroid cancers.

Table 10 Diagnostic Efficacy of the ACR TI-RADS and C-TIRADS Scoring and Classification Systems

Group	Sensitivity	Specificity	PPV	NPV
ACR TI-RADS scoring and classification system	89.53% (231/258)	78.35% (199/254)	80.77% (231/286)	88.05% (199/226)
C-TIRADS scoring and classification system	86.05% (222/258)	81.10% (206/254)	82.22% (222/270)	85.12% (206/242)
χ^2 values	1.465	0.597	0.194	0.861
P values	0.226	0.440	0.659	0.354