Advantages of the Korean Thyroid Imaging Reporting and Data System Combined with Contrast-Enhanced Ultrasound in Diagnosing Papillary Thyroid Microcarcinoma

A papillary thyroid microcarcinoma (PTMC) may have the characteristics of different types of lesions, usually leading
to preoperative ultrasound diagnosis. Therefore, new diagnostic methods need to be developed.

This study aimed to evaluate the advantages of the Korean thyroid imaging reporting and data system (TI-RADS) combined
with contrast-enhanced ultrasound (CEUS) in diagnosing PTMC.
Patients and

In total, 143 patients who had a total of 150 micro space-occupying lesions of the thyroid and underwent
conventional ultrasonography (US) and CEUS were enrolled. The diagnostic value of the benign nodule and PTMC by TIRADS, CEUS
and combined method were compared. The independent US and CEUS predictors for PTCM were determined and quantified using
logistic regression analysis.

The TIRADS + CEUS combination had the highest accuracy (95.10%), sensitivity (96.74%), specificity (94.83%), positive prediction
value (87.92%) and negative prediction value (98.02%), significantly greater than that of TI-RADS alone (area under the curve
[AUC]: 0.930 vs. 0.873, P < 0.001; accuracy: 95.10% vs. 89.78%, P = 0.032; sensitivity: 96.74% vs. 86.05%, P = 0.041; positive predictive
value [PPV]: 87.92% vs. 76.47%, P = 0.029) and CEUS alone (AUC: 0.930 vs. 0.857, P < 0.001; accuracy: 95.10% vs. 86.93%, P < 0.001; negative
predictive value [NPV]: 98.02% vs. 90.83%, P = 0.047). Multivariate stepwise logistic regression showed that calcification (odds
ratio [OR] = 1.586; 95% confidence interval [CI]: 1.037 - 2.311; P = 0.027), hypoechogenicity (OR = 1.432; 95%CI: 0.975 - 1.925; P = 0.035),and hypo-enhancement (OR = 2.140; 95%CI: 1.237 - 2.840; P = 0.019) were the optimal predictor for PTMC.

TI-RADS in combination with CEUS has superior diagnostic efficiency in the discrimination of micro-thyroid spaceoccupying
lesions, which can improve the diagnostic accuracy of PTMC.