A Systematic Review and Meta-analysis on Ultrasound Detection of Thyroid Cancer in China

Background: One major drawback of using ultrasound for diagnosing thyroid nodules is its limited ability to distinguish between benign and malignant nodules. In China, the common methods for risk stratification and guiding fine needle aspiration (FNA) in diagnosing thyroid nodules are the Chinese Thyroid Imaging Reports and Data Systems (C-TIRADS) and American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS). Objectives: This review seeks to assess the effectiveness of C-TIRADS and ACR-TIRADS in accurately identifying the risk of malignancy in Chinese patients suspected of thyroid cancer. Methods: A detailed search was conducted in PubMed, Google Scholar, Medline, Embase, Web of Science, Cochrane, and China National Knowledge Infrastructure (CNKI) databases from January 2018 to December 2022. The analysis only considered original articles from China reporting the use of C-TIRADS and ACR-TIRADS confirmed by histology and FNA. Results: This review analyzed 26 studies with a total of 23,064 thyroid nodules from 19,114 patients to compare the diagnostic performance of C-TIRADS and ACR-TIRADS in predicting malignancy risk in thyroid nodules. Although the malignancy rates in each risk category were similar between the two systems, the TIRADS showed better diagnostic performance than C-TIRADS in terms of pooled specificity (95.0 % vs. 66.8 % of C-TIRADS). However, the pooled analysis showed that C-TIRADS had a better pooled sensitivity (94.6 % vs. 76.5% of ACR-TIRADS). The diagnostic odds ratio was 1.37 (95 % CI: 0.75-2.51) for ACR-TIRADS and 0.89 (95 % CI: 0.36-2.16) for C-TIRADS. Conclusion: Based on the results, both C-TIRADS and ACR-TIRADS are effective in predicting the risk of malignancy in thyroid nodules with similar overall diagnostic accuracy. The combination of both systems can be beneficial in enhancing accuracy in suspicious or uncertain cases. The long-term experience of the trained radiologists can readily help in concluding the diagnosis. As no single system or combination of systems can provide a 100% accurate prediction of the malignancy of thyroid nodules, the ultimate diagnosis relies on the concluding assessment of experienced radiologists and the medical team.