Abstract:

Objective

To analyze the quality of ultrasonic diagnosis of medullary thyroid carcinoma (MTC) and propose measures to improve its accuracy.

Methods

Eighty-one patients with MTC diagnosed by pathology were reviewed at Peking Union Medical College Hospital from January 2019 to December 2022. The sonograms of all the MTCs were retrospectively analyzed using the American Thyroid Association (ATA) risk stratification guidelines, the American College of Radiology thyroid imaging report and data system (ACR-TIRADS), and the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS). Thyroid nodules were re-risk-stratified or classified by 2 physicians using the above three guidelines. The Chi-square test was used to compare the differences in sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, and guideline application rate between physicians with primary or intermediate title (35 cases) and those with senior title (46 cases), and between thyroid professionals (27 cases) and non-thyroid professionals (54 cases), the difference in the coincidence rate of diagnosis made on original ultrasound reports between the group using guidelines and the group not using, and the differences in accuracy of ultrasound report diagnosis, ATA, ACR-TIRADS, and C-TIRADS classification diagnosis.

Results

The sonogram completeness rate for MTC was 88.9% (72/81), the report description completeness rate was 92.6% (75/81), the ultrasound diagnostic coincidence rate was 87.7%(71/81), and the guidelines application rate was 54.3% (44/81). There was no statistically significant difference(P＞0.05) in the sonogram completeness rate, report description completeness rate, ultrasound diagnostic coincidence rate, or guidelines application rate between the primary and intermediate title group and the senior title group, and between the thyroid professional group and non-professional group. The coincidence rates of diagnosis made on original ultrasound reports in the guidelines application group and non-application group were 100% (44/44) and 73.0% (27/37), respectively, with a statistically significant difference (χ²=11.84,P＜0.001). The coincidence rates of ATA, ACR-TIRADS, and C-TIRADS for MTC were significantly higher than that of diagnosis made on ultrasound reports (97.5%, 97.5%, and 97.5% vs 87.7%, χ²=7.551, P=0.006).

Conclusion

The accuracy of preoperative ultrasound diagnosis for MTC is high, but lower than that of ATA,ACR-TIRADS, and C-TIRADS. Ultrasound physicians should be familiar with sonographic features of MTC,apply ultrasound risk stratification systems, and further improve the quality of ultrasound diagnosis.

Key words: Medullary thyroid carcinoma, Ultrasound, Diagnostic quality