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

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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1479: Predictive Value of Color Doppler, RI and B-Mode Ultrasound in the Thyroid Nodules

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2009.06.865 ◽

2009 ◽

Vol 35 (8) ◽

pp. S229

Author(s):

Maria Cristina Chammas ◽

João Pinto ◽

Andre D'Alessandro ◽

Andrea Cavalanti Gomes ◽

Marilia Brescia ◽

...

Keyword(s):

Predictive Value ◽

Thyroid Nodules ◽

Color Doppler

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

Hormone Research in Paediatrics ◽

10.1159/000509118 ◽

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

Introduction: 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. Objectives: 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. Methods: 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. Results: 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). Conclusion: 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.

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Diagnostic performance of thyroid multimodal-imaging comprehensive risk stratification scoring (TMC-RSS) system in characterising thyroid nodules.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17588 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17588-e17588 ◽

Cited By ~ 1

Author(s):

Abhishek Mahajan ◽

Richa Vaish ◽

Supreeta Arya ◽

Nilesh Sable ◽

Shilpa Pande ◽

...

Keyword(s):

Multimodal Imaging ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Color Doppler ◽

Cumulative Risk ◽

Final Analysis ◽

Expert Radiologist ◽

Risk Of Malignancy ◽

Mean Size ◽

Degree Of Confidence

e17588 Background: A univocal ultrasound (US) classification system for characterising thyroid nodules is still lacking. The aim was to create an algorithm (TMC-RSS) using US features in combination with Color Doppler (CD), TIRADS, elastography (ES) and test its diagnostic performance. Methods: Analysis of prospectively collected data over 10 months. All studies were performed on single equipment using standard US protocol with TIRADS scoring. Gold standard was pathology. 340 nodules in 260 patients of which 316 nodules included for final analysis. 148 (46.8%) benign and 168 (53.2%) Malignant. TMC-RSS Multiple Logistic Regression Model. Malignant characteristics:Plus (+) 3 points for: ES score 3/4, malignant nodes. (+) 1 point for: Taller than wider, microcalcification, hypoechogenicity, solid composition, ill-defined margins, central +/- peripheral vascularity. (+) 0.5 point for: irregular halo, size > 1 cm. Benign characteristics:Minus (-) 3 points for: Purely cystic, ES score-1; (-) 1 point for: spongiform, comet tail artefact, complete halo. (-) 0.5 point for: peripheral vascularity. Final TMC-RSS Score calculated by addition of all the points. Results: Mean age was 47.3 yrs. Mean size was 2.3 +/- 1.5 cm. Diagnostic performance of combined US, ES, TIRADS and CD (sensitivity: 96%, specificity: 95%, PPV: 95%, NPV: 96%, kappa: 0.911) was significantly higher (p < .001) than either combination of US, TIRADS, ES, CD. On multivariate analysis all US features except taller than wider were independent predictor of malignancy (p < .01). TMC-RSS Model had 90% sensitivity, 89% specificity and 91% accuracy for characterising nodules. On the ROC curve the cut-off for best performance of TMC-RSS score was 5.75. The cumulative risk of malignancy based on TMC-RSS score was 2.4% for score < 3, 18% for score ≥ 3 - < 6 and 80% for score ≥ 6. Conclusions: The proposed TMC-RSS is easy-to-use, robust, reproducible and provides higher degree of confidence to a non-expert radiologist. It can be the first step in standardization of reporting lexicon to allow effective communication between the radiologists, pathologists, and clinicians; helping avoid unnecessary interventions.

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

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-206445 ◽

2020 ◽

Vol 73 (11) ◽

pp. 722-727 ◽

Cited By ~ 1

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.

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

Endocrine Practice ◽

10.4158/ep-2020-0024 ◽

2020 ◽

Vol 26 (9) ◽

pp. 945-952 ◽

Cited By ~ 2

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

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Risk of malignancy in thyroid nodules: predictive value of puncture feeling of grittiness in the process of fine-needle aspiration

Scientific Reports ◽

10.1038/s41598-017-13391-3 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Jieli Luo ◽

Chao Zhang ◽

Fengbo Huang ◽

Jianshe Chen ◽

Yang Sun ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Fine Needle ◽

Risk Of Malignancy

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Oral Presentation III

World Journal of Endocrine Surgery ◽

10.5005/wjoes-8-1-15 ◽

2016 ◽

Vol 8 (1) ◽

pp. 15-20

Author(s):

Seyed Ziaeddin Rasihashemi ◽

Ali Ramouz ◽

Nassir Rostambeigi

Keyword(s):

Predictive Value ◽

Doppler Ultrasonography ◽

Thyroid Nodules ◽

Color Doppler ◽

Needle Aspiration ◽

Benign Lesions ◽

Fine Needle ◽

Doppler Us ◽

Color Doppler Us ◽

Us Elastography

ABSTRACT BACKGROUND AND AIMS Thyroid nodules occur in more than 50% of populations over 50 years, and only 5% of thyroid nodules are malignant. This study was aimed to evaluate Doppler ultrasonography (US) combined with elastography in the diagnosis of the malignant thyroid nodules with suspicious fine needle aspiration cytological (FNAC) results. METHODS From August 2012 to March 2013, 107 consecutive patients eligible for thyroid surgery enrolled in the study. All patients underwent FNAC study followed by conventional US, color Doppler US, and US elastography with a real-time instrument. Thyroid nodules ultrasonographic parameters were evaluated during conventional and color Doppler US study and elastography performed in order to calculate the strain index (SI) by dividing the strain value of the nodule by that of the peripheral normal parenchyma, prior to thyroidectomy. RESULTS Of 161 nodules in 107 patients, 76 (47.2%) were benign lesions and 85 (52.8%) were malignant. The overall Doppler US score depicted a sensitivity of 64% and specificity of 59%. Using a cut of 2.905, the sensitivity and specificity for elastography US were about 54 and 76% respectively, with positive predictive value of 71.8% and negative predictive value of 59.8%. Evaluating quantitative elastography combined with Doppler US, out of 68 nodules with positive peripheral halo ring, 44 had elasticity ≥ 2.905, which was statistically significant (p < 0.001). CONCLUSION Quantitative elastography combined with Doppler US is more accurate in thyroid nodules diagnosis comparing to other methods and can limit the use of FNAC and the subsequent thyroidectomy in patients with nondiagnostic or unsatisfactory cytological findings.

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

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1033-1351 ◽

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.

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The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

Oncopediatrics ◽

10.15690/onco.v5i1.1862 ◽

2018 ◽

Vol 5 (1) ◽

pp. 13-23

Author(s):

Nikolai S. Grachev ◽

Elena V. Feoktistova ◽

Igor N. Vorozhtsov ◽

Natalia V. Babaskina ◽

Ekaterina Yu. Iaremenko ◽

...

Keyword(s):

Thyroid Cancer ◽

Predictive Value ◽

Thyroid Nodules ◽

Pediatric Patients ◽

Thyroid Neoplasms ◽

Diagnostic Methods ◽

Diagnostic Approach ◽

First Line ◽

Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

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