2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

doi:10.1007/s12020-020-02441-y

Practice Guideline

. 2020 Nov;70(2):256-279.

doi: 10.1007/s12020-020-02441-y. Epub 2020 Aug 21.

2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

JianQiao Zhou¹, LiXue Yin², Xi Wei³, Sheng Zhang³, YanYan Song⁴, BaoMing Luo⁵, JianChu Li⁶, LinXue Qian⁷, LiGang Cui⁸, Wen Chen⁸, ChaoYang Wen⁹, YuLan Peng¹⁰, Qin Chen¹¹, Man Lu¹², Min Chen^{13

14}, Rong Wu¹⁵, Wei Zhou¹⁶, EnSheng Xue¹⁷, YingJia Li¹⁸, LiChun Yang¹⁹, ChengRong Mi²⁰, RuiFang Zhang²¹, Gang Wu²², GuoQing Du²³, DaoZhong Huang²⁴, WeiWei Zhan²⁵; Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association; Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound

Collaborators, Affiliations

Collaborators

BaoMing Luo, BeiJian Huang, ChaoYang Wen, ChengRong Mi, DaoZhong Huang, EnSheng Xue, Gang Wu, GuoQing Du, HaiTao Ran, HuiJuan Xiang, JiaAn Zhu, Jian Wang, JianChu Li, Jie Tang, Jing Li, JingChun Yang, Lei Zhang, LiGang Cui, LingYun Bao, LiXue Yin, Man Lu, Mei Zhu, Min Chen, Nima Yuzhen, PengFei Zhang, Rong Wu, RuiJun Guo, ShaoYun Hao, ShiBao Fang, Tao Chen, WeiWei Zhan, Ying Zhu, YingJia Li, YongPing Lu, YouBin Deng, YuanYi Zheng, Yue Chen, YuKun Luo, YuLan Peng, Bai BaoYan, Cai YuanJin, Chang Xin, Che Guihua, Chen Fu, Chen HongTian, Chen HongYan, Chen HuiPin, Chen Jiehuan, Chen NianQiao, Chen Wu, Chen Xinguang, Chen XiuPing, Cui Guanghe, Dai LiPing, Deng XueDong, Dong LiLi, Du Gang, Fang Chao, Fang FengKai, Fei ZhengDong, Feng LiLi, Fu Jian, Guan Ling, Guo JianQin, Han Wen, He Nianan, He ShaoZheng, He XueMei, Hou AiQin, Hu Jie, Hu LiYan, Huang DingWei, Huang JianYuan, Huang Li, Huang PeiPei, Huang WeiWei, Jia LiQiong, Jiang Xinhui, Kang huiLi, Kong XiangChong, Lei XiaoQing, Li AnYang, Li Chen, Li Cheng, Li ChuanYin, Li Dong, Li HaiYan, Li HongMei, Li HuiWen, Li JianXin, Li Ning, Li QiaoYing, Li QinYing, Li Tao, Li WenDong, Li XingYun, Li Zhao, Liang GuoSheng, Lin Jie, Liu Aihua, Liu HongMin, Liu Jia, Liu Kun, Liu YanChao, Lou KeXin, Lu YeJun, Mao Feng, Miao Juan, Ni XueJun, Pan XiaoJie, Pang Yun, Peng Mei, Peng ZhenYi, Pi YanMin, Qi TingYue, Qin QianMiao, Qing Shunhua, Qu JianFeng, Ren Jinhe, RenaguLi AiSha, Ru RongRong, Shen Tao, Shi HongWei, Shi Jie, Shi LiYing, Shou JinDuo, Song LinLin, Su DeMin, Sun AnYi, Sun Zhuogui, Tang Binhui, Tang Li Na, Wan Qing, Wang Fang, Wang Jing, Wang JinPing, Wang Li, Wang Wei, Wang XinFang, Wang YaLi, Wang YanBin, Wang YanQing, Wang YanZhen, Wang YingChun, Wang YuanSheng, Wang ZhaoRui, Wu ChangJun, Wu HaiYan, Wu Jing, Wu JinYu, Wu Liang, Wu LinSong, Wu Qing, Wu Tao, Wu Ting, Wu WenJing, Wu ZhiLing, Wu ZhongQiu, Xiao LiFang, Xie ChuanWen, Xie Xiaohong, Xu Quan, Xue Dan, Yan JingBin, Yan JiPing, Yang JianQing, Yang Jie, Yang QingYa, Yang XiaoQing, Yang XueWen, Yang Yan, Yang YingMei, Yang Yinguang, Ye Xinhua, Ye YuQuan, You Tao, Yu Liang, Yu XiaoQin, Yuan Hui, Yuan Zhihong, Ze Liang, Zeng Shue, Zhang Hui, Zhang Jian, Zhang JianLei, Zhang LiJuan, Zhang LiLi, Zhang Na, Zhang PanPan, Zhang Tong, Zhang WenJun, Zhang XiaoDong, Zhang Yan, Zhang Yuhong, Zhang Yuhua, Zhang YunFei, Zhang ZiZhen, Zhang ZiZhen, Zhao Feng, Zhao Li, Zhao Yu, Zhou Hong, Zhou JianQiao, Zhou Na, Zhou Peng, Zhou Ruhai, Zhou XianLi, Zhou YiBo, Zhu Bin, Zhu LiSha, Zhu Zheng, Zou Bao

Affiliations

¹ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China. zhousu30@126.com.
² Institute of Ultrasound in Medicine, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China. yinlixue@yahoo.com.
³ Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
⁴ Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
⁵ Department of Ultrasound, SunYat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, China.
⁶ Department of Ultrasound, Peking Union Medical College Hospital, Beijing, 100730, China.
⁷ Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
⁸ Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
⁹ Department of Ultrasound, Peking University International Hospital, Beijing, 102206, China.
¹⁰ Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, China.
¹¹ Department of Ultrasound, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China.
¹² Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, 610041, China.
¹³ Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
¹⁴ Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
¹⁵ Department of Ultrasound, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China.
¹⁶ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁷ Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
¹⁸ Department of Ultrasound, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China.
¹⁹ Department of Ultrasound, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650031, China.
²⁰ Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, 750021, China.
²¹ Department of Ultrasound, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
²² Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, 450003, China.
²³ Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
²⁴ Department of Ultrasound, Tongji Hospital, Tongji Medical Colloge, Huazhong University of Science and Technology, Wuhan, 430030, China.
²⁵ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China. shanghairuijinus@163.com.

PMID: 32827126
DOI: 10.1007/s12020-020-02441-y

Practice Guideline

2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

JianQiao Zhou et al. Endocrine. 2020 Nov.

. 2020 Nov;70(2):256-279.

doi: 10.1007/s12020-020-02441-y. Epub 2020 Aug 21.

Authors

Collaborators

BaoMing Luo, BeiJian Huang, ChaoYang Wen, ChengRong Mi, DaoZhong Huang, EnSheng Xue, Gang Wu, GuoQing Du, HaiTao Ran, HuiJuan Xiang, JiaAn Zhu, Jian Wang, JianChu Li, Jie Tang, Jing Li, JingChun Yang, Lei Zhang, LiGang Cui, LingYun Bao, LiXue Yin, Man Lu, Mei Zhu, Min Chen, Nima Yuzhen, PengFei Zhang, Rong Wu, RuiJun Guo, ShaoYun Hao, ShiBao Fang, Tao Chen, WeiWei Zhan, Ying Zhu, YingJia Li, YongPing Lu, YouBin Deng, YuanYi Zheng, Yue Chen, YuKun Luo, YuLan Peng, Bai BaoYan, Cai YuanJin, Chang Xin, Che Guihua, Chen Fu, Chen HongTian, Chen HongYan, Chen HuiPin, Chen Jiehuan, Chen NianQiao, Chen Wu, Chen Xinguang, Chen XiuPing, Cui Guanghe, Dai LiPing, Deng XueDong, Dong LiLi, Du Gang, Fang Chao, Fang FengKai, Fei ZhengDong, Feng LiLi, Fu Jian, Guan Ling, Guo JianQin, Han Wen, He Nianan, He ShaoZheng, He XueMei, Hou AiQin, Hu Jie, Hu LiYan, Huang DingWei, Huang JianYuan, Huang Li, Huang PeiPei, Huang WeiWei, Jia LiQiong, Jiang Xinhui, Kang huiLi, Kong XiangChong, Lei XiaoQing, Li AnYang, Li Chen, Li Cheng, Li ChuanYin, Li Dong, Li HaiYan, Li HongMei, Li HuiWen, Li JianXin, Li Ning, Li QiaoYing, Li QinYing, Li Tao, Li WenDong, Li XingYun, Li Zhao, Liang GuoSheng, Lin Jie, Liu Aihua, Liu HongMin, Liu Jia, Liu Kun, Liu YanChao, Lou KeXin, Lu YeJun, Mao Feng, Miao Juan, Ni XueJun, Pan XiaoJie, Pang Yun, Peng Mei, Peng ZhenYi, Pi YanMin, Qi TingYue, Qin QianMiao, Qing Shunhua, Qu JianFeng, Ren Jinhe, RenaguLi AiSha, Ru RongRong, Shen Tao, Shi HongWei, Shi Jie, Shi LiYing, Shou JinDuo, Song LinLin, Su DeMin, Sun AnYi, Sun Zhuogui, Tang Binhui, Tang Li Na, Wan Qing, Wang Fang, Wang Jing, Wang JinPing, Wang Li, Wang Wei, Wang XinFang, Wang YaLi, Wang YanBin, Wang YanQing, Wang YanZhen, Wang YingChun, Wang YuanSheng, Wang ZhaoRui, Wu ChangJun, Wu HaiYan, Wu Jing, Wu JinYu, Wu Liang, Wu LinSong, Wu Qing, Wu Tao, Wu Ting, Wu WenJing, Wu ZhiLing, Wu ZhongQiu, Xiao LiFang, Xie ChuanWen, Xie Xiaohong, Xu Quan, Xue Dan, Yan JingBin, Yan JiPing, Yang JianQing, Yang Jie, Yang QingYa, Yang XiaoQing, Yang XueWen, Yang Yan, Yang YingMei, Yang Yinguang, Ye Xinhua, Ye YuQuan, You Tao, Yu Liang, Yu XiaoQin, Yuan Hui, Yuan Zhihong, Ze Liang, Zeng Shue, Zhang Hui, Zhang Jian, Zhang JianLei, Zhang LiJuan, Zhang LiLi, Zhang Na, Zhang PanPan, Zhang Tong, Zhang WenJun, Zhang XiaoDong, Zhang Yan, Zhang Yuhong, Zhang Yuhua, Zhang YunFei, Zhang ZiZhen, Zhang ZiZhen, Zhao Feng, Zhao Li, Zhao Yu, Zhou Hong, Zhou JianQiao, Zhou Na, Zhou Peng, Zhou Ruhai, Zhou XianLi, Zhou YiBo, Zhu Bin, Zhu LiSha, Zhu Zheng, Zou Bao

Affiliations

¹ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China. zhousu30@126.com.
² Institute of Ultrasound in Medicine, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China. yinlixue@yahoo.com.
³ Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
⁴ Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
⁵ Department of Ultrasound, SunYat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, China.
⁶ Department of Ultrasound, Peking Union Medical College Hospital, Beijing, 100730, China.
⁷ Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
⁸ Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
⁹ Department of Ultrasound, Peking University International Hospital, Beijing, 102206, China.
¹⁰ Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, China.
¹¹ Department of Ultrasound, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China.
¹² Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, 610041, China.
¹³ Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
¹⁴ Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
¹⁵ Department of Ultrasound, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China.
¹⁶ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁷ Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
¹⁸ Department of Ultrasound, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China.
¹⁹ Department of Ultrasound, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650031, China.
²⁰ Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, 750021, China.
²¹ Department of Ultrasound, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
²² Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, 450003, China.
²³ Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
²⁴ Department of Ultrasound, Tongji Hospital, Tongji Medical Colloge, Huazhong University of Science and Technology, Wuhan, 430030, China.
²⁵ Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China. shanghairuijinus@163.com.

PMID: 32827126
DOI: 10.1007/s12020-020-02441-y

Abstract

Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound.

Keywords: Biopsy; Diagnostic imaging; Fine needle; Risk assessment; Thyroid nodule; Ultrasonography.

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References

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1. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1), 1–133 (2016). https://doi.org/10.1089/thy.2015.0020 - DOI - PubMed - PMC
1. Z. Chen, W. Xu, Y. Huang, X. Jin, J. Deng, S. Zhu, H. Liu, S. Zhang, Y. Yu, Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. Am. J. Clin. Nutr. 98(3), 684–692 (2013). https://doi.org/10.3945/ajcn.112.054353 - DOI - PubMed
1. J. Yin, C. Wang, Q. Shao, D. Qu, Z. Song, P. Shan, T. Zhang, J. Xu, Q. Liang, S. Zhang, J. Huang, Relationship between the Prevalence of Thyroid Nodules and Metabolic Syndrome in the Iodine-Adequate Area of Hangzhou, China: A Cross-Sectional and Cohort Study. Int J. Endocrinol. 2014, 675796 (2014). https://doi.org/10.1155/2014/675796 - DOI - PubMed - PMC
1. W. Xu, Z. Chen, N. Li, H. Liu, L. Huo, Y. Huang, X. Jin, J. Deng, S. Zhu, S. Zhang, Y. Yu, Relationship of anthropometric measurements to thyroid nodules in a Chinese population. BMJ Open 5(12), e008452 (2015). https://doi.org/10.1136/bmjopen-2015-008452 - DOI - PubMed - PMC

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[1] C. Durante, G. Grani, L. Lamartina, S. Filetti, S.J. Mandel, D.S. Cooper, The diagnosis and management of thyroid nodules: a review. JAMA 319(9), 914–924 (2018). https://doi.org/10.1001/jama.2018.0898 - DOI - PubMed

[2] C. Durante, G. Grani, L. Lamartina, S. Filetti, S.J. Mandel, D.S. Cooper, The diagnosis and management of thyroid nodules: a review. JAMA 319(9), 914–924 (2018). https://doi.org/10.1001/jama.2018.0898 - DOI - PubMed

[3] B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1), 1–133 (2016). https://doi.org/10.1089/thy.2015.0020 - DOI - PubMed - PMC

[4] B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1), 1–133 (2016). https://doi.org/10.1089/thy.2015.0020 - DOI - PubMed - PMC

[5] Z. Chen, W. Xu, Y. Huang, X. Jin, J. Deng, S. Zhu, H. Liu, S. Zhang, Y. Yu, Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. Am. J. Clin. Nutr. 98(3), 684–692 (2013). https://doi.org/10.3945/ajcn.112.054353 - DOI - PubMed

[6] Z. Chen, W. Xu, Y. Huang, X. Jin, J. Deng, S. Zhu, H. Liu, S. Zhang, Y. Yu, Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. Am. J. Clin. Nutr. 98(3), 684–692 (2013). https://doi.org/10.3945/ajcn.112.054353 - DOI - PubMed

[7] J. Yin, C. Wang, Q. Shao, D. Qu, Z. Song, P. Shan, T. Zhang, J. Xu, Q. Liang, S. Zhang, J. Huang, Relationship between the Prevalence of Thyroid Nodules and Metabolic Syndrome in the Iodine-Adequate Area of Hangzhou, China: A Cross-Sectional and Cohort Study. Int J. Endocrinol. 2014, 675796 (2014). https://doi.org/10.1155/2014/675796 - DOI - PubMed - PMC

[8] J. Yin, C. Wang, Q. Shao, D. Qu, Z. Song, P. Shan, T. Zhang, J. Xu, Q. Liang, S. Zhang, J. Huang, Relationship between the Prevalence of Thyroid Nodules and Metabolic Syndrome in the Iodine-Adequate Area of Hangzhou, China: A Cross-Sectional and Cohort Study. Int J. Endocrinol. 2014, 675796 (2014). https://doi.org/10.1155/2014/675796 - DOI - PubMed - PMC

[9] W. Xu, Z. Chen, N. Li, H. Liu, L. Huo, Y. Huang, X. Jin, J. Deng, S. Zhu, S. Zhang, Y. Yu, Relationship of anthropometric measurements to thyroid nodules in a Chinese population. BMJ Open 5(12), e008452 (2015). https://doi.org/10.1136/bmjopen-2015-008452 - DOI - PubMed - PMC

[10] W. Xu, Z. Chen, N. Li, H. Liu, L. Huo, Y. Huang, X. Jin, J. Deng, S. Zhu, S. Zhang, Y. Yu, Relationship of anthropometric measurements to thyroid nodules in a Chinese population. BMJ Open 5(12), e008452 (2015). https://doi.org/10.1136/bmjopen-2015-008452 - DOI - PubMed - PMC

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2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

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2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

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