Frontiers in endocrinology · 2026
Diagnostic performance of adult-based ultrasound ACR-TIRADS and C-TIRADS in adolescent thyroid nodules.
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Liu Jieyu, Jiang Chengxue, Zhang Xiaoye, Zheng Taiqing, Liu Minghui, Wang Guotao
Аннотация
OBJECTIVES: This study aims to evaluate the diagnostic performance of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in differentiating between malignant and benign thyroid nodules in the pediatric population.
MATERIALS AND METHODS: In this retrospective, single-center study, a total of 461 thyroid nodules from 393 pediatric patients (median age, 16.0 years; 91 boys) from September 2018 to November 2024 were analyzed. All diagnostic performance results are reported on a per-nodule basis. Scenario 1 (biopsy recommended for ACR-TR3 nodules ≥35 mm and all ACR-TR5 nodules) and Scenario 2 (biopsy recommended for all C-TR4B, C-TR4C, and C-TR5 nodules, with no biopsy for C-TR4A) were adopted to indicate biopsy. The diagnostic performance, unnecessary biopsy rates, and biopsy triage failure rates of ACR-TIRADS, C-TIRADS, Scenario 1, and Scenario 2 were estimated and compared.
RESULTS: The area under the receiver operating characteristic curve for Scenario 1 and Scenario 2 was significantly higher than that of ACR-TIRADS and C-TIRADS, respectively [0.793 (95% CI: 0.753 -0.829) vs. 0.663 (95% CI: 0.618 -0.706) and 0.825 (95% CI: 0.787 -0.858) vs. 0.689 (95% CI: 0.645 -0.731); both P < 0.01] Furthermore, both scenarios demonstrated lower unnecessary biopsy rates (47.5% vs. 60.1% for Scenario 1; 30.6% vs. 56.8% for Scenario 2) and biopsy triage failure rates (5.4% vs. 13.6% for Scenario 1; 8.8% vs. 12.8% for Scenario 2) compared to the corresponding TIRADS systems.
CONCLUSIONS: These findings suggest that the application of Scenario 1 and Scenario 2 can improve diagnostic performance and reduce both unnecessary biopsy rates and biopsy triage failure rates in identifying malignant thyroid nodules in the pediatric population.
MATERIALS AND METHODS: In this retrospective, single-center study, a total of 461 thyroid nodules from 393 pediatric patients (median age, 16.0 years; 91 boys) from September 2018 to November 2024 were analyzed. All diagnostic performance results are reported on a per-nodule basis. Scenario 1 (biopsy recommended for ACR-TR3 nodules ≥35 mm and all ACR-TR5 nodules) and Scenario 2 (biopsy recommended for all C-TR4B, C-TR4C, and C-TR5 nodules, with no biopsy for C-TR4A) were adopted to indicate biopsy. The diagnostic performance, unnecessary biopsy rates, and biopsy triage failure rates of ACR-TIRADS, C-TIRADS, Scenario 1, and Scenario 2 were estimated and compared.
RESULTS: The area under the receiver operating characteristic curve for Scenario 1 and Scenario 2 was significantly higher than that of ACR-TIRADS and C-TIRADS, respectively [0.793 (95% CI: 0.753 -0.829) vs. 0.663 (95% CI: 0.618 -0.706) and 0.825 (95% CI: 0.787 -0.858) vs. 0.689 (95% CI: 0.645 -0.731); both P < 0.01] Furthermore, both scenarios demonstrated lower unnecessary biopsy rates (47.5% vs. 60.1% for Scenario 1; 30.6% vs. 56.8% for Scenario 2) and biopsy triage failure rates (5.4% vs. 13.6% for Scenario 1; 8.8% vs. 12.8% for Scenario 2) compared to the corresponding TIRADS systems.
CONCLUSIONS: These findings suggest that the application of Scenario 1 and Scenario 2 can improve diagnostic performance and reduce both unnecessary biopsy rates and biopsy triage failure rates in identifying malignant thyroid nodules in the pediatric population.