The first Chinese version of TIRADS: C-TIRADS classification of 6 special types of thyroid nodules

In my country, the prevalence of thyroid nodules found by ultrasound examination is as high as 20% to 35%, but most of them are benign nodules, of which about 7% to 15% are thyroid cancer (according to age, sex, radiation history, family history) Different from other factors).

Ultrasonography is the first choice for imaging examination of thyroid nodules, and it has important value in clinical diagnosis and treatment decisions.

However, there are currently as many as 10 versions of TIRADS, the grading standard of the thyroid imaging report and data system used in hospitals throughout my country, which is very inconsistent.

To this end, the organization experts of the Superficial Organs and Angiology Group of the Ultrasonic Medicine Branch of the Chinese Medical Association began to draft the Chinese version of TIRADS in 2017, aiming to establish a C-TIRADS that conforms to China's national conditions.

Recently, "2020 Chinese Guidelines for Ultrasound Risk Stratification of Thyroid Nodules: C-TIRADS" was published in the Chinese Journal of Ultrasound Imaging.

This article is an excerpt from the chapter on "Classification of Several Special Types of Cases" to share with you.

(See the end of the article for the download link of the full version of the guide) Ultrasound assessment classification (C-TIRADS) and treatment recommendations for thyroid nodules The expert committee adopts counting method to establish C-TIRADS, that is, by counting suspicious ultrasound features (solid, microcalcification, very low echo) , Blurred edges, irregular edges or extra-thyroid invasion, and vertical position are suspicious malignant ultrasound features, while comet tail artifacts are benign features) are scored.
If comet tail artifacts exist, the total score will be reduced.
Go to 1, and get the nodule risk stratification based on the final score.

 Table 1 C-TIRADS based on counting method Note: * No nodules, no points assigned Note: Vertical position can be assessed in cross section or longitudinal section; punctate strong echo can be divided into microcalcification, comet tail artifact and meaningless Clarify the three types.

When the above three types of punctate strong echo appear in the nodule at the same time, only the microcalcification is recorded, and 1 point is added to the count.

Comet tail artifacts are only recorded when there is no strong point echoes with microcalcifications, and are counted down by 1 point.

Figure 1 Classification of Chinese Thyroid Ultrasound Reporting and Data System (C-TIRADS) established by counting method Classification of several special types of cases 1.
Cystic nodules and cavernous nodules Cystic nodules and cavernous nodules are usually Benign, can be assessed as C-TIRADS category 2.

Attention should be paid to the definition of spongy nodules.
There can be no solid components inside the nodules.

(A: Almost completely cystic nodule, with internal debris echo, C-TIRADS 2, diagnosis: nodular goiter;) (B: ​​cavernous nodule, C-TIRADS 2, diagnosis: nodular goiter ;) 2.
Uniform hyperechoic nodules under the background of Hashimoto’s thyroiditis.
Uniform hyperechoic nodules appearing under the background of Hashimoto’s thyroiditis.
The diameter is generally no more than 15 mm, typically under 10 mm.
These so-called "white" "White knight" nodules are typical benign nodules and can be assessed as C-TIRADS category 2.

(C: White Knight's nodules in the background of Hashimoto's thyroiditis, C-TIRADS 2, diagnosis: Hashimoto's thyroiditis;) 3.
Nodular goiter According to literature and expert opinions, multiple findings with similar ultrasound appearances appear in the thyroid gland.
When the dominant nodule is sexual and/or cystic, the corresponding pathological diagnosis is usually nodular goiter, with a low probability of malignancy.
This type of condition can be assessed as C-TIRADS category 3.

(D: Multiple solid and cystic primary nodules with similar ultrasound findings, C-TIRADS 3, diagnosis: nodular goiter;) 4.
Nodular calcification leads to internal features that cannot be assessed for some with coarse calcification or For nodules with marginal calcification, the acoustic shadow caused by calcification can cause the internal characteristics of the nodules to be undiagnosed.

According to the ACR-TIRADS guidelines, such nodules can be assessed as at least ACR-TIRADS category 4, with a risk of malignancy >5%.

Such nodules are classified as C-TIRADS 4A.

(E: The acoustic shadow caused by the coarse calcification of the nodule causes the internal characteristics of the nodule to be undiagnosed, C-TIRADS 4A, diagnosis: nodular goiter;) 5.
"Blizzard-like" microcalcification nodules appear in the thyroid nodules and it is difficult to count A large number of microcalcifications, the so-called "blizzard-like" microcalcifications.

This type of calcification has a specificity of 100% in the diagnosis of malignancy, so it can be assessed as C-TIRADS category 5.

  (F: Nodules with blizzard-like microcalcifications, C-TIRADS 5, diagnosis: papillary carcinoma;) 6.
Diffuse microcalcifications that are not related to nodules, there are a large number of diffuse distributions in unilateral or bilateral thyroid parenchyma Strong echogenic calcification, typically "blizzard-like", which is common in diffuse sclerosing papillary carcinoma of the thyroid.

If there is a typical thyroid cancer metastatic lymph node in the neck, it can be assessed as C-TIRADS category 5.

If there are no suspicious lymph nodes in the neck, it can be assessed as category 4B or higher or even category 5 based on clinical experience.

  (G: Snowstorm-like microcalcification unrelated to nodules in the right thyroid, C-TIRADS 5, diagnosis: papillary carcinoma) Full text download link: http://rs.
yiigle.
com/CN131148202103/1315209.
htm The above content is taken from : Superficial Organs and Angiology Group of Ultrasound Medicine Branch of Chinese Medical Association, China Thyroid and Breast Ultrasound Artificial Intelligence Alliance.
2020 Chinese Guidelines for Ultrasound Risk Stratification of Thyroid Nodules: C-TIRADS[J].
Chinese Journal of Ultrasound Imaging, 2021 , 30 (3): 185-200.
DOI: 10.
3760/cma.
j.
cn131148-20210205-00092.