Objective:

To compare the diagnostic efficacy of 2011 Kwak Thyroid Imaging Report and Data System (TI-RADS)

2015 American Thyroid Association (ATA) guidelines for Adult thyroid nodules and differentiated thyroid cancer (ATA guidelines)

2017 American College of Radiology (ACR) TI-RADS and 2020 China guidelines for malignant risk stratification of thyroid

nodules: C TI-RADS issued by the Ultrasonic Medical Branch of Chinese Medical Association in 2020

these four thyroid nodule

grading systems

in children with benign and malignant thyroid nodules.

Methods:

A retrospective analysis was conducted on 80

pediatric patients with thyroid nodules who underwent thyroid ultrasound examinations in Children’s Hospital of Fudan University

between January 1

2008

and December 31

2021. These patients also underwent thyroid fine-needle aspiration biopsy or surgical

treatment to confirm pathological results. Thyroid nodules were retrospectively graded based on the Kwak TI-RADS

ATA guidelines

ACR TI-RADS

and C TI-RADS. The final pathological results were used as the gold standard. Malignancy rates for different risk

stratifications were calculated

and receiver operating characteristic (ROC) curves were plotted to compare the area under curve (AUC)

diagnostic sensitivity

and specificity of these four grading systems.

Results:

The sensitivity of ATA guidelines

Kwak TI-RADS

ACR TI-RADS

and C TI-RADS were 85.7%

74.3%

71.4%

and 77.1%

respectively. The specificity were 64.4%

66.7%

80.0%

and 69.3%

respectively. The AUC values were 0.764

0.772

0.809

and 0.770

respectively. All 4 grading systems demonstrated

relatively high diagnostic performance for pediatric thyroid nodules

with ACR TI-RADS having slightly higher diagnostic

performance compared to the other three guidelines (

P

＜0.05). The optimal cutoff values for these four methods were ACR TI-RADS

4

Kwak TI-RADS 4c

highly suspicious for malignancy in ATA guidelines

and 4C (highly suspicious for malignancy) in C TI-

RADS.

Conclusion:

Applying the four adult thyroid ultrasound risk stratification criteria to children demonstrates good diagnostic

performance

with ACR TI-RADS exhibiting higher diagnostic performance compared to the other three methods.