Context

Ultrasound-based risk stratification systems (Thyroid Imaging Reporting and Data Systems (TIRADSs)) of thyroid nodules (TNs) have been implemented in clinical practice worldwide based on their high performance. However, it remains unexplored whether different TIRADSs perform uniformly across a range of TNs in routine practice. This issue is highly relevant today, given the ongoing international effort to establish a unified TIRADS (i.e. I-TIRADS), supported by the leading societies specializing in TNs. The study aimed to conduct a direct comparison among ACR-, EU-, and K-TIRADS in the distribution of TNs: (1) across the TIRADS categories, and (2) based on their estimated cancer risk.

Methods

A search was conducted on PubMed and Embase until June 2023. Original studies that sequentially assessed TNs using TIRADSs, regardless of FNAC indication, were selected. General study characteristics and data on the distribution of TNs across TIRADSs were extracted.

Results

Seven studies, reporting a total of 41,332 TNs, were included in the analysis. The prevalence of ACR-TIRADS 1–2 was significantly higher than that of EU-TIRADS 2 and K-TIRADS 2, with no significant difference observed among intermediate- and high-risk categories of TIRADSs. According to malignancy risk estimation, K-TIRADS often classified TNs as having more severe risk, ACR-TIRADS as having moderate risk, and EU-TIRADS classified TNs as having lower risk.

Conclusion

ACR-, EU-, and K-TIRADS assess TNs similarly across their categories, with slight differences in low-risk classifications. Despite this, focusing on cancer risk estimation, the three TIRADSs assess TNs differently. These findings should be considered as a prerequisite for developing the I-TIRADS.

中文翻译：

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美国、欧洲和亚洲 TIRADS 在甲状腺结节评估中的头对头比较：系统评价和荟萃分析

语境

基于超声的甲状腺结节 (TN) 风险分层系统（甲状腺成像报告和数据系统 (TIRADS)）因其高性能而已在全球临床实践中得到应用。然而，在日常实践中，不同的 TIRADS 在一系列 TN 中是否表现一致仍有待探索。鉴于国际社会正在努力建立统一的 TIRADS（即 I-TIRADS），并得到专门从事 TN 的领先协会的支持，这个问题在今天具有高度的相关性。该研究旨在对 ACR-、E​​U-和 K-TIRADS 的 TN 分布进行直接比较：(1) 跨 TIRADS 类别，(2) 基于其估计的癌症风险。

方法

在 PubMed 和 Embase 上进行了一项检索，直至 2023 年 6 月。选择了使用 TIRADS 连续评估 TN 的原始研究，无论 FNAC 适应症如何。提取了 TIRADS 中 TN 分布的一般研究特征和数据。

结果

分析中纳入了七项研究，报告了总共 41,332 个 TN。ACR-TIRADS 1-2 的患病率显着高于 EU-TIRADS 2 和 K-TIRADS 2，而中危和高危类别的 TIRADS 之间没有观察到显着差异。根据恶性肿瘤风险评估，K-TIRADS通常将TN分类为具有较高风险，ACR-TIRADS将TN分类为具有中度风险，而EU-TIRADS将TN分类为具有较低风险。

结论

ACR-、E​​U-和 K-TIRADS 对各个类别的 TN 进行类似的评估，但低风险分类方面略有差异。尽管如此，三个 TIRADS 均以癌症风险评估为重点，以不同方式评估 TN。这些发现应被视为开发 I-TIRADS 的先决条件。