Table 10.

Inappropriate FNA rate, missed FNA rate of malignant nodules, FNA rate of benign nodules and area under the curve of recommended threshold and optimized threshold in the application guideline.

	Combined inappropriate FNA and missed FNA	Missed FNA of malignant nodules	Inappropriate FNA of benign nodules	AUC
ATA	91/217 (41.9%)	31/139 (22.3%)	60/78 (76.9%)	0.504
ACR TIRADS	56/217 (25.8%)	34/139 (24.5%)	22/78 (28.2%)	0.737
ATA high suspicion removal greater than 1cm threshold	67/217 (30.9%)	6/139 (4.3%)	61/78 (78.2%)	0.587
ACR5 removal greater than 1cm threshold	34/217(15.7%)	11/139(7.9%)	23/78 (29.5%)	0.813

Inappropriate FNA was defined as the number of benign nodules punctured. A statistical difference existed between two AUCs of the above four standards (P<0.001). The accuracy of using the ACR TI-RADS guidelines to guide FNA was higher than that of ATA guidelines. After the ACR TI-RADS guidelines relaxed the limit of 1cm for TR5 nodules, the efficiency of guiding FNA was further improved, with the combined inappropriate FNA and missed FNA rate reduced to 15.7%, the malignant nodule missed FNA rate reduced to 7.9%, the inappropriate FNA rate of 29.5%, and the area under the curve increased to 0.813.