International Journal of Clinical Research

Objective To evaluate the clinical value of thyroid imaging reporting and data system (TI-RADS) classification in the differential diagnosis of benign and malignant thyroid nodules in physical examination population. Methods A retrospective cohort study was conducted, including 5296 physical examinees who underwent thyroid screening in our hospital from January 2023 to January 2024. The detected nodules were risk-stratified according to TI-RADS classification criteria. Pathological results of surgical resection were used as the gold standard for malignant nodules. TI-RADS category 4a and above nodules with pathological biopsy indications were confirmed by pathology, while TI-RADS category 2 and 3 low-risk nodules were judged as benign according to clinical diagnosis and treatment guidelines (without pathological biopsy indications). The diagnostic performance indexes of TI-RADS classification were calculated based on the above stratified verification method. Results Among 5296 physical examinees, 2371 were found to have thyroid nodules, with a detection rate of 44.77%. The detection rate in females was slightly higher than that in males, and the detection rate in people aged 30 and above increased with age. Among the detected nodules, there were 1622 cases (68.41%) of TI-RADS category 2, 1290 cases (54.40%) of category 3, 130 cases (5.48%) of category 4a, and no cases of category 4b and above were detected. Among the 130 TI-RADS category 4a nodules verified by pathology, 18 cases were diagnosed as malignant, with a malignant rate of 13.85%. For TI-RADS category 4a and above, the diagnostic sensitivity for thyroid malignant nodules was 100.00%, specificity 98.79%, accuracy 98.54%, and positive predictive value 13.85%. With the increase of TI-RADS grade, the incidence of malignant ultrasonic features such as solid components, hypo/extremely hypoechoic, aspect ratio ＞1, irregular margin and microcalcification of nodules increased significantly. Conclusion TI-RADS classification has high practical value in the differential diagnosis of benign and malignant thyroid nodules in physical examination population. The sensitivity of 100% can achieve no missed diagnosis of malignant nodules, and the high specificity can effectively reduce unnecessary examinations and treatments for low-risk nodules and optimize the allocation of medical resources. Clinically, TI-RADS classification can be used for stratified management of thyroid nodules in physical examination population, providing a reliable basis for accurately formulating diagnosis and treatment plans and early detecting thyroid cancer.

Color Doppler ultrasound; TI-RADS classification; Thyroid nodules; Physical examination screening; Benign/malignant differentiation; Stratified verification