Objective:

To evaluate the diagnostic performance of a contrast-enhanced ultrasound-based Thyroid Imaging Reporting and Data System (CEUS TI-RADS) compared to K-TIRADS for differentiating benign from malignant thyroid nodules and to assess its ability to reduce unnecessary fine-needle aspirations (FNAs).

Approach:

• Study Design: Retrospective analysis of 175 thyroid nodules in patients who underwent FNA and/or surgical resection between January 2022 and December 2023.
• Classification: Nodules were classified according to both K-TIRADS and CEUS TI-RADS criteria, with pathological results serving as the reference standard.
• Statistical Analysis: Receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic efficacy, and multivariate logistic regression was used to identify independent predictors of malignancy.

Key Findings:

• CEUS TI-RADS showed a higher diagnostic performance than K-TIRADS, with an AUC of 0.893 versus 0.804 (P < 0.05).
• The unnecessary biopsy rate (UBR) was significantly lower for CEUS TI-RADS at 18.6% compared to 44.8% for both K-TIRADS 2016 and K-TIRADS 2021 (P < 0.01).
• Independent predictors of malignancy included hypoechoic echogenicity, irregular or lobulated margins, punctate echogenic foci, and hypoenhancement.
• Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated but not specified in the original summary.

Interpretation:

Conclusion: