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已发表论文
回声分级对 C-TIRADS 诊断效能的影响
Authors Huang GL, Su JY, Liang RQ, Yang XY , Xu LF
Received 20 May 2025
Accepted for publication 30 August 2025
Published 15 September 2025 Volume 2025:18 Pages 5509—5517
DOI https://doi.org/10.2147/IJGM.S541530
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Woon-Man Kung
Ge-Lang Huang,1,* Jing-Yan Su,2,* Rui-Qiao Liang,3 Xi-Yue Yang,3 Li-Fang Xu4
1Department of Rehabilitation, Guigang Peoples’s Hospital, Guigang, Guangxi Zhuang Autonomous Region, People’s Republic of China; 2Department of Radiology, Guangxi Zhuang Autonomous Region Corps Hospital of Chinese People’s Armed Police Force, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China; 3Department of Diagnostic Ultrasound, Guigang Peoples’s Hospital, Guigang, Guangxi Zhuang Autonomous Region, People’s Republic of China; 4Department of Diagnostic Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Li-Fang Xu, Department of Diagnostic Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, No. 166, Daxuedong Road East, Nanning, Guangxi Zhuang Autonomous Region, 530007, People’s Republic of China, Email 651425409@qq.com
Purpose: To investigate whether echogenicity grading can improve the diagnostic performance of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS).
Patients and methods: Ultrasonic (US) images of 646 thyroid nodules (TNs) were retrospectively reviewed. The sonographic features of each nodule were analyzed and noted, including the orientation, margin, composition, echogenicity, echogenic foci, and extrathyroidal extension. Hypoechoic was further graded as mildly, moderately and markedly hypoechoic, and the malignancy risk at different echogenicity levels was compared. Each nodule was categorized according to C-TIRADS using markedly hypoechoic, modified markedly hypoechoic, and hypoechoic as malignant indicators, and the classification results were recorded as TI-RADS 1, 2, and 3, respectively. The diagnostic sensitivity, specificity, and area under the curve (AUC) of the different echogenicity and TIRADS were compared using chi-square analysis and Receiver Operating Characteristic curves (ROC). Binary logistic regression analysis was used to calculate cancer risk for different echogenicity. The interobserver agreement in the grading of echogenic of the nodules was also assessed.
Results: Most malignant nodules were hypoechoic (85.2%), and the malignancy risk of hypoechoic nodules was significantly higher than that of iso-hyperechoic nodules (34.4% vs 9.8%). The malignancy risk gradually increased as nodule echogenicity decreased (odd ratios (ORs) of 2.132, 10.009, and 15.006, respectively). There was no significant difference in the malignancy risk between moderately and markedly hypoechoic nodules (P=0.203). The modified markedly hypoechoic region showed the highest AUC and the most balanced sensitivity and specificity for the diagnosis of thyroid cancer. The diagnostic performance of TI-RADS 2 was significantly higher than that of TI-RADS 1 and 3 (AUC of 0.715, 0.608, and 0.656, respectively). Substantial agreement was obtained between the two observers in grading markedly hypoechoic and modified markedly hypoechoic (κ = 0.79 and 0.75; 95% CI: 0.75,0.83 and 0.64,0.86).
Conclusion: Stratifying hypoechogenic to three degrees enhances confidence in evaluating malignancy risk. Compared to markedly hypoechoic, the modified markedly hypoechoic significantly boosted the ability of C-TIRADS to differentiate benign TNs from malignant ones.
Keywords: ultrasound, thyroid nodule, echogenicity, thyroid imaging reporting and data system, diagnostic performance
1Department of Rehabilitation, Guigang Peoples’s Hospital, Guigang, Guangxi Zhuang Autonomous Region, People’s Republic of China; 2Department of Radiology, Guangxi Zhuang Autonomous Region Corps Hospital of Chinese People’s Armed Police Force, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China; 3Department of Diagnostic Ultrasound, Guigang Peoples’s Hospital, Guigang, Guangxi Zhuang Autonomous Region, People’s Republic of China; 4Department of Diagnostic Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Li-Fang Xu, Department of Diagnostic Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, No. 166, Daxuedong Road East, Nanning, Guangxi Zhuang Autonomous Region, 530007, People’s Republic of China, Email 651425409@qq.com
Purpose: To investigate whether echogenicity grading can improve the diagnostic performance of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS).
Patients and methods: Ultrasonic (US) images of 646 thyroid nodules (TNs) were retrospectively reviewed. The sonographic features of each nodule were analyzed and noted, including the orientation, margin, composition, echogenicity, echogenic foci, and extrathyroidal extension. Hypoechoic was further graded as mildly, moderately and markedly hypoechoic, and the malignancy risk at different echogenicity levels was compared. Each nodule was categorized according to C-TIRADS using markedly hypoechoic, modified markedly hypoechoic, and hypoechoic as malignant indicators, and the classification results were recorded as TI-RADS 1, 2, and 3, respectively. The diagnostic sensitivity, specificity, and area under the curve (AUC) of the different echogenicity and TIRADS were compared using chi-square analysis and Receiver Operating Characteristic curves (ROC). Binary logistic regression analysis was used to calculate cancer risk for different echogenicity. The interobserver agreement in the grading of echogenic of the nodules was also assessed.
Results: Most malignant nodules were hypoechoic (85.2%), and the malignancy risk of hypoechoic nodules was significantly higher than that of iso-hyperechoic nodules (34.4% vs 9.8%). The malignancy risk gradually increased as nodule echogenicity decreased (odd ratios (ORs) of 2.132, 10.009, and 15.006, respectively). There was no significant difference in the malignancy risk between moderately and markedly hypoechoic nodules (P=0.203). The modified markedly hypoechoic region showed the highest AUC and the most balanced sensitivity and specificity for the diagnosis of thyroid cancer. The diagnostic performance of TI-RADS 2 was significantly higher than that of TI-RADS 1 and 3 (AUC of 0.715, 0.608, and 0.656, respectively). Substantial agreement was obtained between the two observers in grading markedly hypoechoic and modified markedly hypoechoic (κ = 0.79 and 0.75; 95% CI: 0.75,0.83 and 0.64,0.86).
Conclusion: Stratifying hypoechogenic to three degrees enhances confidence in evaluating malignancy risk. Compared to markedly hypoechoic, the modified markedly hypoechoic significantly boosted the ability of C-TIRADS to differentiate benign TNs from malignant ones.
Keywords: ultrasound, thyroid nodule, echogenicity, thyroid imaging reporting and data system, diagnostic performance