A Comparison of Different Thyroid Imaging Reporting and Data Systems to Reduce Unnecessary FNAs and Missed Malignancies

2021 ◽  
pp. 875647932110550
Author(s):  
Ehsan Seif ◽  
Mostafa Qorbani ◽  
Shaghayegh Mousavi ◽  
Ali Salahshoor
Keyword(s):  
Artificial Intelligence ◽  
Thyroid Nodules ◽  
Scoring Systems ◽  
Data System ◽  
Data Systems ◽  
Fine Needle ◽  
Conservative Method ◽  
Thyroid Imaging ◽  
The Eu

Objective: The Thyroid Imaging Reporting and Data System (TIRADS) has been proposed to reduce the number of unnecessary fine needle aspirations (FNA) from thyroid nodules. Materials and Methods: An individual radiologist provided sonographic examinations and FNA on a collection of 188 thyroid nodules. The recommendations based on the TIRADS system, for each nodule, was determined and evaluated against the cytology results. Results: The American College of Radiology (ACR), artificial intelligence (AI), European (EU), and Korean (K) scoring systems reduced FNAs by 53%, 56%, 48%, and 28%, respectively. Among those lesions without a recommendation for immediate FNA, The ACR would have missed four malignant nodules, the AI would have missed four malignant nodules, and K TIRADS would have missed three malignant nodules but with a recommended follow-up imaging. The ACR would have missed three malignant nodules, the AI would have missed four malignant nodules, and EU TIRADS would have missed four malignant nodules, without a recommended follow-up examination. The highest and lowest kappa interrelated agreements were between ACR and AI (0.902) and AI and K (0.448). Conclusion: The ACR and AI TIRADS could substantially decrease the number of FNAs but rely on follow-up imaging. The EU TIRADS reduced the number of FNAs, the least however this system had less dependence on follow-up imaging. The K TIRADS was the most conservative method and the least dependent on follow-up diagnostics.

scholarly journals Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5439
Author(s):  
Davide Seminati ◽  
Giulia Capitoli ◽  
Davide Leni ◽  
Davide Fior ◽  
Francesco Vacirca ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Scoring Systems ◽  
Needle Aspiration ◽  
Data Systems ◽  
Predictive Values ◽  
Radiological Features ◽  
Benign Nodules ◽  
Design And Methods ◽  
The Eu

Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting >TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.

scholarly journals Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1,000 nodules

2016 ◽  
Vol 14 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Antonio Rahal Junior ◽  
Priscila Mina Falsarella ◽  
Rafael Dahmer Rocha ◽  
João Paulo Bacellar Costa Lima ◽  
Matheus Jorge Iani ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Data System ◽  
Fine Needle ◽  
Thyroid Imaging ◽  
Bethesda System ◽  
Bethesda Classification ◽  
The Bethesda System

ABSTRACT Objective To correlate the Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda system in reporting cytopathology in 1,000 thyroid nodules. Methods A retrospective study conducted from November 2011 to February 2014 that evaluated 1,000 thyroid nodules of 906 patients who underwent ultrasound exam and fine needle aspiration. Results A significant association was found between the TI-RADS outcome and Bethesda classification (p<0.001). Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and 92.5%, respectively). Among those classified as TI-RADS 4C and 5, most presented Bethesda 6 (68.2% and 91.3%, respectively; p<0.001). The proportion of malignancies among TI-RADS 2 was 0.8%, and TI-RADS 3 was 1.7%. Among those classified as TI-RADS 4A, proportion of malignancies was 16.0%, 43.2% in 4B, 72.7% in 4C and 91.3% among TI-RADS 5 (p<0.001), showing clear association between TI-RADS and biopsy results. Conclusion The TI-RADS is appropriate to assess thyroid nodules and avoid unnecessary fine needle aspiration, as well as to assist in making decision about when this procedure should be performed.

GUIDELINE IMPLEMENTATION ON FINE-NEEDLE ASPIRATION FOR THYROID NODULES: FOCUSING ON MICRONODULES

2020 ◽  
Vol 26 (9) ◽  
pp. 1017-1025
Author(s):  
Si Eun Lee ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
Vivian Youngjean Park ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Guideline Implementation ◽  
Needle Aspiration ◽  
Data System ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Thyroid Imaging

Objective: We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines. Methods: Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation. Results: The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) ( P<.001). Conclusion: Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules. Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; FNA = fine-needle aspiration; K-TIRADS = Korean Thyroid Imaging Reporting and Data System; LN = lymph node; TIRADS = Thyroid Imaging Reporting and Data System; US = ultrasound

Diagnostic value of 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) combined with fine needle aspiration biopsy in thyroid nodules

2021 ◽  
pp. 1-10
Author(s):  
Chao Zhang ◽  
Yu-Qin Huang ◽  
Zhi-Long Liu
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Diagnostic Value ◽  
Needle Aspiration ◽  
Data System ◽  
Fine Needle ◽  
Thyroid Imaging ◽  
Accuracy Increase ◽  
Sensitivity Specificity

OBJECTIVE: To evaluate diagnostic value of Thyroid Imaging Reporting and Data System published by American College of Radiology (ACR TI-RADS) in 2017, ultrasound-guided fine-needle aspiration (US-FNA), and the combination of both methods in differentiation between benign and malignant thyroid nodules. METHODS: The data of US-FNA and ACR TI-RADS are collected from 159 patients underwent thyroid surgery in our hospital, which include a total of 178 thyroid nodules. A Bethesda System for Reporting Thyroid Cytopathology category of ≥IV and an ACR TI-RADS category ≥4 are regarded as diagnosis standards for malignancy in US-FNA and ACR TI-RADS, respectively. The pathological results after surgery are considered as the gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ACR TI-RADS, US-FNA and the combination of both methods for the differential diagnosis of thyroid nodules are calculated, respectively. RESULTS: The sensitivity, specificity and accuracy of ACR TI-RADS are 85.4%, 37.5%and 72.5%, respectively. The sensitivity, specificity and accuracy of US-FNA are 70.0%, 100%and 78.1%, respectively. After combining these two methods, the sensitivity, specificity and accuracy increase to 99.23%, 37.50%and 82.58%, respectively. The sensitivity of ACR TI-RADS is higher than that of US-FAN, and the sensitivity of combining these two methods is also higher than that of using ACR TI-RADS and US-FNA alone. CONCLUSION: The established ACR TI-RADS can help in selecting the target during nodule puncture, while the combination of ACR TI-RADS and US-FAN can further improve diagnostic ability for detecting malignant thyroid 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.

scholarly journals Follow-up of Benign Thyroid Nodules—Can We Do Less?

2019 ◽  
Vol 70 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Manijeh Mohammadi ◽  
Carrie Betel ◽  
Kirsteen Rennie Burton ◽  
Kevin McLughlin Higgins ◽  
Zeina Ghorab ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Descriptive Study ◽  
Needle Aspiration ◽  
Thyroid Malignancy ◽  
Fine Needle ◽  
Nodule Size ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Objective To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign. Methods This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up. Results A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily. Conclusion In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management.

Application of Thyroid Imaging Reporting and Data System in the Ultrasound Assessment of Thyroid Nodules According to Physician Experience

2016 ◽  
Vol 32 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Su Yeon Ko ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
Ha Yan Kim ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Imaging ◽  
Ultrasound Assessment

scholarly journals Risk of Malignancy in Thyroid Nodules Using the American College of Radiology Thyroid Imaging Reporting and Data System in the NIFTP Era

2018 ◽  
Vol 50 (10) ◽  
pp. 735-737 ◽  
Author(s):  
Pedro Rosario ◽  
Alexandre da Silva ◽  
Maurício Nunes ◽  
Michelle Borges
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Neoplasm ◽  
Malignant Tumours ◽  
Thyroid Imaging ◽  
Risk Of Malignancy ◽  
Nuclear Features

AbstractRecently, the American College of Radiology (ACR) proposed a Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodules based on ultrasonographic features. It is important to validate this classification in different centres. The present study evaluated the risk of malignancy in solid nodules>1 cm using ACR TI-RADS. The risk of malignancy was defined including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and after its exclusion from malignant tumours. For the present study, the original images were revised, and each nodule was assigned to one of the TI-RADS levels proposed for solid nodules: TR3, TR4, or TR5. This risk of malignancy was significantly different for the three levels: 1.7%, 11.2%, and 60.6% for TR3, TR4, and TR5, respectively, when NIFTP was included, and 0.6%, 7.9%, and 60.2% for TR3, TR4, and TR5, respectively, when NIFTP was excluded from malignant tumours. The nodules corresponding to NIFTP were classified according to ACR as TR3 in 28.5% of cases, TR4 in 67.8%, and TR5 in only 3.5%. The nodules corresponding to cancer were classified according to ACR as TR3 in only 2.3% of cases, TR4 in 27%, and TR5 in 70.5%. In conclusion, this study shows the validity of the ACR TI-RADS for solid thyroid nodules, even after the exclusion of NIFTP from malignant tumours.

Thyroid imaging reporting and data system (TI‐RADS) of the American College of Radiology (ACR) for predicting malignancy in thyroid nodules >1 cm with indeterminate cytology

2018 ◽  
Vol 47 (5) ◽  
pp. 523-525 ◽  
Author(s):  
Tiara Grossi Rocha ◽  
Pedro Weslley Rosario ◽  
Alexandre Lemos Silva ◽  
Maurício Buzelin Nunes ◽  
Maria Regina Calsolari
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Imaging ◽  
Indeterminate Cytology
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