advantages of the korean thyroid imaging reporting and data system combined with contrast-enhanced ultrasound in diagnosing papillary thyroid microcarcinoma

Background: 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. objectives: 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 methods: 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 ti-rads, ceus and combined method were compared. the independent us and ceus predictors for ptcm were determined and quantified using logistic regression analysis. results: the ti-rads + 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. conclusion: 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.