Predictive value of positive ultrasound signs based on C-TIRADS guidelines for malignant risk of thyroid nodules
Hou Yingying1, Chen Ce2, Du Xiaoying1, Sun Yixue1
1Department of Ultrasound, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China; 2Department of Ultrasound, Bengbu First People's Hospital, Bengbu 233000, China
Abstract：Objective To investigate the value of positive ultrasound signs based on the "2020 Chinese Guidelines for Malignant Risk Stratification of Thyroid nodules :C-TIRADS" (abbreviated as C-TIRADS guidelines) in the prediction of malignant risk of thyroid nodules. Methods This study was a retrospective cohort study. The clinical data of 266 patients with solid thyroid nodules (272 nodules) who had ultrasound indicating signs of malignancy and underwent thyroid fine needle aspiration biopsy (FNAB) from May 2022 to May 2023 in the First Affiliated Hospital of Bengbu Medical University were included. They were 18-87 (55.5 ± 3.5) years old, 50 were males, and 216 were females. A total of 225 nodules were surgically removed from 223 cases: 41 males and 182 females. The cytopathological results of FNAB puncture cells were analyzed. The consistency of the postoperative cytopathological results with the histopathological results of the surgical patients was evaluated. Using FNAB cytopathology results as the gold standard, the positive ultrasound signs of C-TIRADS guidelines, microcalcification, extremely low echo, vertical position, fuzzy margin, gender, age, nodule location, nodule volume, and other clinical data were included in univariate and logistic multivariate regression analyses for identifying risk factors affecting the occurrence of malignant thyroid nodules. Results (1) FNAB cytopathology results showed that 80 of the 272 nodules were malignant and the rest were benign. In addition, 11 of 60(18.3%) nodules had blurred margins or extrathyroid invasion, 27 of 111 (24.3%) nodules had microcalcifications, 24 of 68 (33.8%) vertical nodules were malignant, and 19 of 33(57.6%) nodules with extreme hypoechoics. (2) The postoperative histopathological results showed that 81 of the 225 nodules were malignant (79 with the same FNAB cytopathological results,97.5%), 144 were benign (143 with the same FNAB cytopathological results,99.3%), and the Kappa value was 0.971 (all P values <0.001). (3) The results of univariate analysis showed that sex, age, microcalcification, extremely low echo, vertical position, and fuzzy margin in the benign and malignant nodules were statistically significant (all P values<0.05). Logistic regression analysis showed that age (odds ratio [OR]=0.965), microcalcification (OR=2.566), and extremely low echo (OR=5.487) were independent risk factors for the occurrence of malignant thyroid nodules (all P values<0.05), and vertical position and fuzzy margin were independent risk factors for the occurrence of malignant thyroid nodules (all P values >0.05). Conclusion The positive ultrasound signs of C-TIRADS guidelines have good diagnostic value for evaluating benign and malignant thyroid nodules, and extremely low echo and microcalcification are independent risk factors for the occurrence of malignant thyroid nodules.
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Hou Yingying, Chen Ce, Du Xiaoying, Sun Yixue. Predictive value of positive ultrasound signs based on C-TIRADS guidelines for malignant risk of thyroid nodules. Chinese Journal of Anatomy and Clinics, 2023, 28(12): 782-786.
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2023, Vol. 28 
