A Simplified Ultrasonographic Score for the Prediction of Cytologically Suspicious Thyroid Nodules

2020 ◽  
Author(s):  
Loredana Pagano ◽  
Alessandro Bisceglia ◽  
Fabrizio Riganti ◽  
Sara Garberoglio ◽  
Ruth Rossetto ◽  
...  
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
False Negatives ◽  
Irregular Margin ◽  
The Us ◽  
Risk Of Malignancy ◽  
Clinically Significant ◽  
Good Diagnostic Accuracy ◽  
Us Scan ◽  
Better Than

Abstract Purpose The major aim of ultrasound (US)-based risk stratification systems is to reduce unnecessary thyroid biopsies without losing the ability to recognize nodules with clinically significant malignancy. Each of the classic suspicious features of a thyroid nodule detected on US scan (hypoechoic pattern, microcalcifications, irregular margin, taller than wide shape, irregular vascularization) is significantly independently associated with the probability of malignancy, but none of them has good diagnostic accuracy. Thus, we evaluated the predictive value of a binary score simply based on the combination of these US features, regardless of the specific predictive value of each US feature, against the outcome of suspected malignancy at cytological diagnosis (TIR3 to TIR5 categories by SIAPEC-IAP [TIR+]). Materials and Methods 1009 thyroid nodules from 1081 patients were considered. The US features of suspicion of all nodules were categorized in 5 binary scores (U1 to U5), each including from 1 to 5 of those features. Results U2 (at least 2 US suspicious features) was the most balanced predictor of TIR+ (PPV 0.48, NPV 0.93, LR+ 3.05 and LR– 0.24). Weighting the predictivity of the single features did not improve the estimate. Using U2 as the criterion to send nodules to FNAC would have reduced the number of biopsies by 60 % (604 patients) and the false negatives would have only accounted for 41 cases out of 237 TIR+ (17 %) with 39 cases of TIR3 and 2 cases of TIR4, including only 6 malignant nodules on histological examination. U2 performed much better than the ATA recommendations for detecting those nodules, resulting in TIR+ at cytology. Conclusion This simple and reproducible sonographic score based on 2 US features of suspicion of malignancy has quite a good performance with respect to identifying thyroid lesions categorized by cytology as medium-high risk of malignancy and could allow us to reduce cytology costs for low-risk nodules.

scholarly journals ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thayse Lozovoy Madsen Barbosa ◽  
Cleo Otaviano Mesa Junior ◽  
Hans Graf ◽  
Teresa Cavalvanti ◽  
Marcus Adriano Trippia ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Institutional Review ◽  
The Us ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

scholarly journals Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

2020 ◽  
Vol 9 (1) ◽  
pp. 236 ◽  
Author(s):  
Simone Schenke ◽  
Rigobert Klett ◽  
Philipp Seifert ◽  
Michael C. Kreissl ◽  
Rainer Görges ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Cohort Analysis ◽  
Medullary Carcinoma ◽  
Data Systems ◽  
Thyroid Imaging ◽  
Promising Tool ◽  
Risk Of Malignancy

Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.

Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

2020 ◽  
Vol 93 (4) ◽  
pp. 239-244
Author(s):  
Shruthi Arora ◽  
Jane Khoury ◽  
Andrew T. Trout ◽  
Janet Chuang
Keyword(s):  
Predictive Value ◽  
Lower Risk ◽  
Thyroid Nodules ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Needle Aspiration ◽  
Risk Category ◽  
American Thyroid Association ◽  
Risk Of Malignancy

<b><i>Introduction:</i></b> The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. <b><i>Objectives:</i></b> To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. <b><i>Methods:</i></b> A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. <b><i>Results:</i></b> A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7–22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9–99.6) and the positive predictive value was 83.3% (95% CI 57.2–98.2). <b><i>Conclusion:</i></b> Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.

The value of superb microvascular imaging (SMI) scoring assignment method in differentiating benign and malignant thyroid nodules by conventional ultrasound

2021 ◽  
pp. 1-9
Author(s):  
Wei Zhao ◽  
Ruigang Lu ◽  
Li Yin ◽  
Ruijun Guo
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Distribution Patterns ◽  
Diagnostic Efficacy ◽  
Assignment Method ◽  
Group 4 ◽  
Before And After ◽  
Conventional Ultrasound ◽  
Group 5 ◽  
Better Than

PURPOSE: To explore the application value of SMI scoring assignment method combined with 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in differentiating benign and malignant thyroid nodules. METHODS: According to the 2017 ACR TI-RADS classification, the enrolled nodules were divided into 3 points group, 4 points group, 5 points group, 6 points group and≥7 points group. The nodules were assigned scores according to the echocity of the nodules and the microvessels detected by SMI and their distribution patterns based on ACR TI-RADS. Accompany with the scores increased or decreased after assignment, the thyroid nodules were re-grouped. RESULTS: The AUC after the scores assignment is better than before (Z = 3.881, P <  0.001). The specificity, positive predictive value and accuracy after score assigned are better than those of before (Z = 8.323, P <  0.001; Z = 8.619, P <  0.001; Z = 5.345, P <  0.001), there is no statistical difference in sensitivity before and after score assigned (Z = –0.513, P = 0.60), and the negative predictive value before assigned score is better than that of after (Z = –3.826, P <  0.001). CONCLUSION: The diagnostic efficacy after scoring was better than that of before.

scholarly journals Risk of Malignancy in Nonpalpable Thyroid Nodules: Predictive Value of Ultrasound and Color-Doppler Features

2002 ◽  
Vol 87 (5) ◽  
pp. 1941-1946 ◽  
Author(s):  
Enrico Papini ◽  
Rinaldo Guglielmi ◽  
Antonio Bianchini ◽  
Anna Crescenzi ◽  
Silvia Taccogna ◽  
...  
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Color Doppler ◽  
Risk Of Malignancy

Fine-Needle Aspiration Cytodiagnosis of the « Cold » Thyroid Nodule

1989 ◽  
Vol 75 (5) ◽  
pp. 475-477 ◽  
Author(s):  
Michele Giansanti ◽  
Silvio Monico ◽  
Paolo Fugiani
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Thyroid Neoplasms ◽  
Needle Aspiration ◽  
False Negatives ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Test Efficiency ◽  
Needle Aspiration Cytology

The results of 1886 fine-needle cytoaspirations of solid, palpable thyroid nodules, « cold » on scintiscanning, performed between 1 January 1978 and 31 December 1986, were analyzed. In total 36 diagnoses of malignancy were made (1.9%). The results of cytologic and histologic examinations were compared in 114 cases to verify the diagnostic accuracy of this method; there was agreement in 98 cases and discordance in 16 consisting of 13 false negatives (11.4%) and 3 false positives (2.6 %). The sensitivity was 77.9 %, specificity 94.5 %, positive predictive value 93.8 %, negative predictive value 80 % and test efficiency 86 %. These values are in the range of those reported in the literature and confirm the validity of fine-needle aspiration cytology in the preoperative diagnosis of thyroid neoplasms.

Preoperative detection of malignancy in fine-needle aspiration cytology (FNAC) smears with indeterminate cytology (Bethesda III, IV) by a combined molecular classifier

2020 ◽  
Vol 73 (11) ◽  
pp. 722-727 ◽  
Author(s):  
Sergei Titov ◽  
Pavel S Demenkov ◽  
Sergei A Lukyanov ◽  
Sergei V Sergiyko ◽  
Gevork A Katanyan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Molecular Markers ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Cytological Analysis ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

AimsAnalysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Previously, we have developed an algorithm for the differential diagnosis of thyroid nodules by means of a small set of molecular markers. Here, we aimed to validate this approach using FNA cytology samples of Bethesda categories III and IV, in which preoperative detection of malignancy by cytological analysis is impossible.MethodsA total of 122 FNA smears from patients with indeterminate cytology (Bethesda III: 13 patients, Bethesda IV: 109 patients) were analysed by real-time PCR regarding the preselected set of molecular markers (the BRAF V600E mutation, normalised concentrations of HMGA2 mRNA, 3 microRNAs, and the mitochondrial/nuclear DNA ratio). The decision tree–based classifier was used to discriminate between benign and malignant tumours.ResultsThe molecular testing detected malignancy in FNA smears of indeterminate cytology with 89.2% sensitivity, 84.6% positive predictive value, 92.9% specificity and 95.2% negative predictive value; these characteristics are comparable with those of more complicated commercial tests. Residual risk of malignancy for the thyroid nodules that were shown to be benign by this molecular method did not exceed the reported risk of malignancy for Bethesda II histological diagnosis. Analytical-accuracy assessment revealed required nucleic-acid input of ≥5 ng.ConclusionsThe study shows feasibility of preoperative differential diagnosis of thyroid nodules of indeterminate cytology using a small panel of molecular markers of different types by a simple PCR-based method using stained FNA smears.

scholarly journals CAN THE AMERICAN THYROID ASSOCIATION, K-TIRADS, AND ACR-TIRADS ULTRASOUND CLASSIFICATION SYSTEMS BE USED TO PREDICT MALIGNANCY IN BETHESDA CATEGORY IV NODULES?

2020 ◽  
Vol 26 (9) ◽  
pp. 945-952 ◽  
Author(s):  
Wei Yang ◽  
Ghaneh Fananapazir ◽  
Jennifer LaRoy ◽  
Machelle Wilson ◽  
Michael J. Campbell
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Classification Systems ◽  
Data System ◽  
Risk Category ◽  
American Thyroid Association ◽  
Thyroid Imaging ◽  
Grading Systems ◽  
Risk Of Malignancy

Objective: Management of thyroid nodules with Bethesda category III and IV cytology on fine needle aspiration (FNA) is challenging as they cannot be adequately classified as benign or malignant. Ultrasound (US) patterns have demonstrated the utility in evaluating the risk of malignancy (ROM) of Bethesda category III nodules. This study aims to evaluate the value of 3 well-established US grading systems (American Thyroid Association [ATA], Korean Thyroid Imaging Reporting and Data System [Korean-TIRADS], and The American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS]) in determining ROM in Bethesda category IV nodules. Methods: Ninety-two patients with 92 surgically resected thyroid nodules who had Bethesda category IV cytology on FNA were identified. Nodule images were retrospectively graded using the 3 systems in a blinded manner. Associations between US risk category and malignant pathology for each system were analyzed. Results: Of the 92 nodules, 56 (61%) were benign and 36 (39%) were malignant. Forty-seven per cent of ATA high risk nodules, 53% of K-TIRADS category 5 nodules, and 50% of ACR-TIRADS category 5 nodules were malignant. The ATA high-risk category had 25% sensitivity, 82% specificity, 47% positive predictive value (PPV) for malignancy. K-TIRADS category 5 had 25% sensitivity, 85% specificity, 53% PPV for malignancy. ACR-TIRADS category 5 had 25% sensitivity, 84% specificity, 50% PPV for malignancy. None of the 3 grading systems yielded a statistically significant correlation between US risk category and the ROM ( P = .30, .72, .28). Conclusion: The ATA, Korean-TIRADS, and ACR-TIRADS classification systems are not helpful in stratifying ROM in patients with Bethesda category IV nodules. Clinicians should be cautious of using ultra-sound alone when deciding between therapeutic options for patients with Bethesda category IV thyroid nodules. Abbreviations: ACR-TIRADS = The American College of Radiology Thyroid Imaging Reporting and Data System; ATA NSP = American Thyroid Association nodule sonographic patterns and risk of malignancy classification system; FN = follicular neoplasm; FNA = fine needle aspiration; FTC = follicular thyroid carcinoma; FVPTC = follicular variant of papillary thyroid carcinoma; HCC = Hurthle cell carcinoma; HCN = Hurthle cell neoplasm; K-TIRADS = Korean Thyroid Imaging Reporting and Data System; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; NPV = negative predictive value; PPV = positive predictive value; ROM = risk of malignancy; US = ultrasound

scholarly journals Reliability of a computer-aided system in the evaluation of indeterminate ultrasound images of thyroid nodules

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
J L Reverter ◽  
L Ferrer-Estopiñan ◽  
F Vázquez ◽  
S Ballesta ◽  
S Batule ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Risk Stratification ◽  
Real World ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Ultrasound Images ◽  
Cad System ◽  
The Us ◽  
Computer Aided

Introduction Computer-aided diagnostic (CAD) programs for malignancy risk stratification from ultrasound (US) imaging of thyroid nodules are being validated both experimentally and in real-world practice. However, they have not been tested for reliability in analyzing difficult or unclear images. Methods US images with indeterminate characteristics were evaluated by five observers with different experience in US examination and by a commercial CAD program. The nodules, on which the observers widely agreed, were considered concordant and, if there was little agreement, not concordant or difficult to assess. The diagnostic performance of the readers and the CAD program was calculated and compared in both groups of nodule images. Results In the group of concordant thyroid nodules (n = 37), the clinicians and the CAD system obtained similar levels of accuracy (77.0% vs 74.2%, respectively; P = 0.7) and no differences were found in sensitivity (SEN) (95.0% vs 87.5%, P = 0.2), specificity (SPE) (45.5 vs 49.4, respectively; P = 0.7), positive predictive value (PPV) (75.2% vs 77.7%, respectively; P = 0.8), nor negative predictive value (NPV) (85.6 vs 77.7, respectively; P = 0.3). When analyzing the non-concordant nodules (n = 43), the CAD system presented a decrease in accuracy of 4.2%, which was significantly lower than that observed by the experts (19.9%, P = 0.02). Conclusions Clinical observers are similar to the CAD system in the US assessment of the risk of thyroid nodules. However, the AI system for thyroid nodules AmCAD-UT® showed more reliability in the analysis of unclear or misleading images.

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