Macrocalcifications Do Not Alter Malignancy Risk Within the American Thyroid Association Sonographic Pattern System When Present in Non-High Suspicion Thyroid Nodules

Thyroid ◽  
2021 ◽  
Author(s):  
Kristen Kobaly ◽  
Caroline S. Kim ◽  
Jill E. Langer ◽  
Susan J Mandel
Keyword(s):  
Thyroid Nodules ◽  
American Thyroid Association ◽  
Malignancy Risk ◽  
Sonographic Pattern

scholarly journals Modified Models for Predicting Malignancy Using Ultrasound Characters Have High Accuracy in Thyroid Nodules With Small Size

2021 ◽  
Vol 8 ◽  
Author(s):  
Shan Jiang ◽  
Qingji Xie ◽  
Nan Li ◽  
Haizhen Chen ◽  
Xi Chen
Keyword(s):  
High Risk ◽  
Thyroid Carcinoma ◽  
Odds Ratio ◽  
Thyroid Nodules ◽  
American Thyroid Association ◽  
High Risk Patients ◽  
Malignancy Risk ◽  
Association Management ◽  
Risk Patients ◽  
Ultrasound Features

To assess the malignancy risk of thyroid nodules, ten ultrasound characteristics are suggested as key diagnostic markers. The European Thyroid Association Guidelines (EU-TIRADS) and 2015 American Thyroid Association Management Guidelines (2015ATA) are mainly used for ultrasound malignancy risk stratification, but both are less accurate and do not appropriatetly classify high risk patients in clinical examination. Previous studies focus on papillary thyroid carcinoma (PTC), but follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC) remained to be characterized. Thus, this study aimed to determine the diagnostic accuracy and establish models using all ultrasound features including the nodule size for predicting the malignancy of thyroid nodules (PTC, FTC, and MTC) in China. We applied logistic regression to the data of 1,500 patients who received medical treatment in Shanghai and Fujian. Ultrasound features including taller-than-wide shape and invasion of the thyroid capsule showed high odds ratio (OR 19.329 and 4.672) for PTC in this dataset. Invasion of the thyroid also showed the highest odds ratio (OR = 8.10) for MTC. For FTC, the halo sign has the highest odds ratio (OR = 13.40). Four ultrasound features revealed distinct OR in PTC nodule groups with different sizes. In this study, we constructed a logistic model with accuracy up to 80%. In addition, this model revealed more accuracy than TIRADS in 4b and 4c category nodules. Hence, this model could well predict malignancy in small nodules and classify high-risk patients.

Use of Predictive Modeling to Tailor Molecular Testing Utilization for Thyroid Nodules

2021 ◽  
pp. 019459982110041
Author(s):  
Sadia T. Ahmed ◽  
Stevyn Fernandes ◽  
Qi Gao ◽  
Thomas J. Ow ◽  
Richard V. Smith ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Endocrinology ◽  
Positive Association ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Single Institution ◽  
Malignancy Risk ◽  
Estimation System

Objective Various risk stratification systems for cytologically indeterminate thyroid nodules are available. However, malignancy risk assessment data, such as ultrasound features, are not always used when the decision is to order molecular testing or not. Our aim was to investigate the utility of molecular testing after incorporating an algorithm with ultrasound-based risk of malignancy (ROM) estimation. Study Design Diagnostic/prognostic study. Setting Single-institution urban tertiary care center. Methods We performed a single-institution retrospective chart review of all thyroid nodules that had undergone molecular testing. A web-based Malignancy Risk Estimation System for Thyroid Nodules was utilized with ultrasound findings to stratify malignancy risk according to the Korean Thyroid Imaging Reporting and Data System (TI-RADS), French TI-RADS, American Association of Clinical Endocrinology guideline, and American Thyroid Association guideline. A novel algorithm for utilizing molecular testing at our institution was developed with the Korean TI-RADS and with recommendations from the American Thyroid Association and National Comprehensive Cancer Network. Results The Korean TI-RADS performed best in our population (area under the curve = 0.83). A positive molecular test result had a positive association with a higher ROM according to all 4 models ( P < .05). Use of our algorithm prior to molecular testing would have prevented 38% of benign/low-ROM negative nodules (n = 28) from being tested. Conclusion In patients with indeterminate thyroid nodules, an algorithm built on pre- and posttest probability to guide molecular testing might reduce unnecessary testing of benign and low-risk nodules.

scholarly journals Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1948
Author(s):  
You-Bin Lee ◽  
Young-Lyun Oh ◽  
Jung-Hee Shin ◽  
Sun-Wook Kim ◽  
Jae-Hoon Chung ◽  
...  
Keyword(s):  
Roc Curve ◽  
Thyroid Nodules ◽  
Positive Likelihood Ratio ◽  
Roc Curves ◽  
The Other ◽  
American Thyroid Association ◽  
Data Systems ◽  
Malignancy Rate ◽  
Line P ◽  
The Eu

We compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsatisfactory aspirations from April 2011 to March 2016, malignancy was detected in 39 of 89 excised nodules. The minimum malignancy rate was 7.82% in EU-TIRADS 5 and 1.87–3.00% in EU-TIRADS 3–4. In the other systems, the minimum malignancy rate was 14.29–16.19% in category 5 and ≤3% in the remaining categories. Although the EU-TIRADS category ≥ 5 exhibited the highest positive likelihood ratio (LR) of only 2.214, category ≥ 5 in the other systems yielded the highest positive LR of >5. Receiver operating characteristic (ROC) curves of all systems to predict malignancy were located statistically above the diagonal nondiscrimination line (P for ROC curve: EU-TIRADS, 0.0022; all others, 0.0001). The areas under the ROC curve (AUCs) were not significantly different among the four systems. The ATA guidelines, K-TIRADS, and ACR TIRADS may be useful to guide management for nondiagnostic/unsatisfactory nodules. The EU-TIRADS, although also useful, exhibited inferior performance in predicting malignancy for nondiagnostic/unsatisfactory nodules in Korea, an iodine-sufficient area.

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