Endocrine Abstracts

Objectives: The aim of this study was to evaluate the diagnostic performance of biopsy criteria in four society ultrasonography (US)-based risk stratification systems (RSSs) or thyroid imaging reporting and data system (TIRADS) including the 2021 Korean (K)-TIRADS for thyroid nodules.

Methods: Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched and other eligible articles by manual search were included to identify original articles investigating diagnostic performance of biopsy criteria for thyroid nodules (≥ 1 cm) in widely used society RSSs including American College of Radiology (ACR)-TIRADS, American Thyroid Association (ATA) system, European (EU)-TIRADS, and 2016/2021 K-TIRADS.

Results: Eleven articles were included. The pooled sensitivity and specificity of US-based RSSs were 82% (95% CI: 74-87%) and 60% (95% CI: 52-67%) for ACR-TIRADS, 89% (95% CI: 85-93%) and 34% (95% CI: 26-42%) for ATA system, 88% (95% CI: 81-92%) and 42% (95% CI: 22-67%) for EU-TIRADS, and 96% (95% CI: 94-97%) and 21% (95% CI: 17-25%) for 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI: 74−79%) and 50% (95% CI: 49−52%) for the 2021 K-TIRADS_1.5 (1.5 cm cut-off for intermediate suspicion nodule) and 91% (95% CI: 89-93%) and 40% (95% CI: 38−41%) for the 2021 K-TIRADS_1.0 (1.0 cm cut-off for intermediate suspicion nodule) in a multicenter study. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI: 32-49%), 65% (95% CI: 56-74%), 68% (95% CI: 60-75%), and 79% (95% CI: 74-83%), respectively. The unnecessary biopsy rate was 50% (95% CI: 47-53%) for the 2021 K-TIRADS_1.5 and 60% (95% CI: 59-62%) for the 2021 K-TIRADS_1.0.

Conclusions: The unnecessary biopsy rate of the 2021 K-TIRADS_1.5 was substantially lower compared with that of 2016 K-TIRADS and comparable to that of ACR-TIRADS. The 2021 K-TIRADS may help reduce the potential harm due to unnecessary biopsy.