Correction to: Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines by Ha EJ, Na DG, Moon W-J, Lee YH, and Choi N. Thyroid 2018;28:1532–1537. DOI: 10.1089/thy.2018.0094

Abstract Context The prevalence of thyroid nodules in the general population is increasingly high, and at least half of those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as “rule-out” tests that can identify nodules that do not require fine-needle aspiration (FNA) cytology. Objective To comparatively assess the performances of five internationally endorsed sonographic classification systems [those of the American Thyroid Association, the American Association of Clinical Endocrinologists, the American College of Radiology (ACR), the European Thyroid Association, and the Korean Society of Thyroid Radiology] in identifying nodules whose FNAs can be safely deferred and to estimate their negative predictive values (NPVs). Design Prospective study of thyroid nodules referred for FNA. Setting Single academic referral center. Patients Four hundred seventy-seven patients (358 females, 75.2%); mean (SD) age, 55.9 (13.9) years. Main Outcome Measures Number of biopsies classified as unnecessary, false-negative rate (FNR), sensitivity, specificity, predictive values, and diagnostic ORs for each system. Results Application of the systems’ FNA criteria would have reduced the number of biopsies performed by 17.1% to 53.4%. The ACR Thyroid Imaging Reporting and Data System (TIRADS) allowed the largest reduction (268 of 502) with the lowest FNR (NPV, 97.8%; 95% CI, 95.2% to 99.2%). Except for the Korean Society of Thyroid Radiology TIRADS, all other systems exhibited significant discriminatory performance but produced significantly smaller reductions in the number of procedures. Conclusions Internationally endorsed sonographic risk stratification systems vary widely in their ability to reduce the number of unnecessary thyroid nodule FNAs. The ACR TIRADS outperformed the others, classifying more than half the biopsies as unnecessary with a FNR of 2.2%.

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Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems

European Thyroid Journal ◽

10.1159/000504219 ◽

2019 ◽

Vol 9 (2) ◽

pp. 85-91 ◽

Cited By ~ 6

Author(s):

Giorgio Grani ◽

Livia Lamartina ◽

Valeria Ramundo ◽

Rosa Falcone ◽

Cristiano Lomonaco ◽

...

Keyword(s):

Risk Stratification ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Negative Impact ◽

Lower Sensitivity ◽

Intraobserver Variability ◽

Transverse Diameter ◽

American Thyroid Association ◽

Alternative Definition ◽

The Impact

Introduction: A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. To potentially improve the reliability of the TTW definition, we propose an arbitrary ratio of ≥1.2. Objective: The aim of this study was to estimate the impact of this definition on diagnostic performance. Methods: We prospectively analyzed 553 thyroid nodules referred for cytology evaluation at an academic center. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2). Results: The alternative definition classified fewer nodules as TTW (28, 5.1% vs. 94, 17%). The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. When applied to sonographic risk stratification systems, however, the proposed definition would increase the number of avoided biopsies (up to 58.2% for ACR TIRADS) and the specificity of all systems, without negative impact on sensitivity or diagnostic odds ratio. Conclusions: Re-defining TTW nodules as those with an AP/T ratio ≥1.2 improves this marker’s specificity for malignancy. Using this definition in risk stratification systems will increase their specificity, reducing the number of suggested biopsies without significantly diminishing their overall diagnostic performance.

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Diagnostic performance evaluation of different TI-RADS using ultrasound computer-aided diagnosis of thyroid nodules: An experience with adjusted settings

PLoS ONE ◽

10.1371/journal.pone.0245617 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245617

Author(s):

Nonhlanhla Chambara ◽

Shirley Y. W. Liu ◽

Xina Lo ◽

Michael Ying

Keyword(s):

Diagnostic Performance ◽

Thyroid Nodules ◽

Computer Aided Diagnosis ◽

Ultrasound Images ◽

American Thyroid Association ◽

Korean Society ◽

Cad System ◽

Computer Aided ◽

Aided Diagnosis ◽

Default Setting

Background Thyroid cancer diagnosis has evolved to include computer-aided diagnosis (CAD) approaches to overcome the limitations of human ultrasound feature assessment. This study aimed to evaluate the diagnostic performance of a CAD system in thyroid nodule differentiation using varied settings. Methods Ultrasound images of 205 thyroid nodules from 198 patients were analysed in this retrospective study. AmCAD-UT software was used at default settings and 3 adjusted settings to diagnose the nodules. Six risk-stratification systems in the software were used to classify the thyroid nodules: The American Thyroid Association (ATA), American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR-TIRADS), British Thyroid Association (BTA), European Union (EU-TIRADS), Kwak (2011) and the Korean Society of Thyroid Radiology (KSThR). The diagnostic performance of CAD was determined relative to the histopathology and/or cytology diagnosis of each nodule. Results At the default setting, EU-TIRADS yielded the highest sensitivity, 82.6% and lowest specificity, 42.1% while the ATA-TIRADS yielded the highest specificity, 66.4%. Kwak had the highest AUROC (0.74) which was comparable to that of ACR, ATA, and KSThR TIRADS (0.72, 0.73, and 0.70 respectively). At a hyperechoic foci setting of 3.5 with other settings at median values; ATA had the best-balanced sensitivity, specificity and good AUROC (70.4%; 67.3% and 0.71 respectively). Conclusion The default setting achieved the best diagnostic performance with all TIRADS and was best for maximizing the sensitivity of EU-TIRADS. Adjusting the settings by only reducing the sensitivity to echogenic foci may be most helpful for improving specificity with minimal change in sensitivity.

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Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm

Frontiers in Oncology ◽

10.3389/fonc.2021.592927 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xuehua Xi ◽

Ying Wang ◽

Luying Gao ◽

Yuxin Jiang ◽

Zhiyong Liang ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Low Risk ◽

Validation Dataset ◽

Intermediate Risk ◽

Solid Mass ◽

Incidence And Mortality ◽

Risk Stratification Model

BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules > 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules < 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules > 4 cm.MethodsA total of 279 thyroid nodules > 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules > 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules > 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules > 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules > 4 cm. A risk stratification model for nodules > 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making.

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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)

Journal of Clinical Medicine ◽

10.3390/jcm9010236 ◽

2020 ◽

Vol 9 (1) ◽

pp. 236 ◽

Cited By ~ 3

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.

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Thyroid Nodules with Indeterminate Cytology: Utility of the American Thyroid Association Sonographic Patterns for Cancer Risk Stratification

Thyroid ◽

10.1089/thy.2018.0085 ◽

2018 ◽

Vol 28 (8) ◽

pp. 1004-1012 ◽

Cited By ~ 26

Author(s):

Pablo Valderrabano ◽

Melissa J. McGettigan ◽

Cesar A. Lam ◽

Laila Khazai ◽

Zachary J. Thompson ◽

...

Keyword(s):

Cancer Risk ◽

Risk Stratification ◽

Thyroid Nodules ◽

American Thyroid Association ◽

Sonographic Patterns ◽

Indeterminate Cytology

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Risk Stratification in Patients With Follicular Neoplasm on Cytology: Use of Quantitative Characteristics and Sonographic Patterns

Frontiers in Endocrinology ◽

10.3389/fendo.2021.614630 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ming-Hsun Wu ◽

Kuen-Yuan Chen ◽

Min-Shu Hsieh ◽

Argon Chen ◽

Chiung-Nien Chen

Keyword(s):

Risk Stratification ◽

Thyroid Nodules ◽

Region Of Interest ◽

Diagnostic Value ◽

Follicular Neoplasm ◽

American Thyroid Association ◽

Cad System ◽

Hospital Patients ◽

Risk Of Malignancy ◽

Us Findings

ObjectivesDifferentiating thyroid nodules with a cytological diagnosis of follicular neoplasm remains an issue. The goal of this study was to determine whether ultrasonographic (US) findings obtained preoperatively from the computer-aided detection (CAD) system are sufficient to further stratify the risk of malignancy for this diagnostic cytological category.MethodsFrom September 2016 to September 2018 in our hospital, patients diagnosed with Bethesda category IV (follicular neoplasm or suspicion of follicular neoplasm) thyroid nodules and underwent surgical excisions were include in the study. Quantification and analysis of tumor features were performed using CAD software. The US findings of the region of interest, including index of composition, margin, echogenicity, texture, echogenic dots indicative of calcifications, tall and wide orientation, and margin were calculated into computerized values. The nodules were further classified into American Thyroid Association (ATA) and American College of Radiology Thyroid Imaging Reporting & Data System (TI-RADS) categories.Results92 (10.1%) of 913 patients were diagnosed with Bethesda category IV thyroid nodules. In 65 patients, the histological type of the nodule was identified. The quantitative features between patients with benign and malignant conditions differed significantly. The presence of heterogeneous echotexture, blurred margins, or irregular margins was shown to have the highest diagnostic value. The risks of malignancy for nodules classified as having very low to intermediate suspicion ATA, non-ATA, and high suspicion ATA patterns were 9%, 35.7%, and 51.7%, respectively. Meanwhile, the risks of malignancy were 12.5%, 26.1%, and 53.8% for nodules classified as TIRADS 3, 4, and 5, respectively. When compared to human observers, among whom poor agreement was noticeable, the CAD software has shown a higher average accuracy.ConclusionsFor patients with nodules diagnosed as Bethesda category IV, the software-based characterizations of US features, along with the associated ATA patterns and TIRADS system, were shown helpful in the risk stratification of malignancy.

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