MON-526 Comparison of ACR-TIRADS to American Thyroid Association Guidelines: Can We Choose Wisely Without Missing Malignancy?

Abstract Thyroid ultrasound has been widely used to determine which nodules need further work up. The goal of this study was to apply the new ACR-TIRADs criteria to a retrospective data set and compare the outcomes to the ATA scoring system. Methods: In a retrospective study, ultrasonographic images of the all nodules biopsied in 2015 were reviewed by radiologists, blinded to fine needle aspiration (FNA) biopsy result, using a checklist to report the image. The checklist was prepared based on 2015 ATA guideline. The ultrasonographic characteristics of thyroid nodules were compared with the result of biopsy to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of checklist in predicting malignancy. These results were published previously. The same data was then reviewed using the ACR-TiRADS tool to assess the number of US and FNA that would been avoided and the number of non-benign cytologies that would have been avoided had these criteria guided care in 2015. Results: 419 thyroid nodules were reviewed 7.1% were malignant, 10.3% were FLUS and 78.3% were benign. Sensitivity of the ACR-TIRADs and ATA respectively was to detect non-benign nodules was 70% and 97% Specificity was 29% and 11%. Positive predictive value was 18% and 9% whereas Negative predictive value was 81% and 98%. 28% of the FNAs done in 2015 could have been avoiding if applying the TIRADs criteria, however 15 non-benign and 8 malignant cases would have been missed.Conclusion: The TIRADs approach adds value to the system by reducing many unnecessary biopsies but clinicians need to use their own judgement as some non-benign cases will be missed.

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Retrospective Application of the 2015 American Thyroid Association Guidelines for Ultrasound Classification, Biopsy Indications, and Follow-up Imaging of Thyroid Nodules: Can Improved Reporting Decrease Testing?

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2018.09.001 ◽

2019 ◽

Vol 70 (1) ◽

pp. 68-73 ◽

Cited By ~ 3

Author(s):

Manijeh Mohammadi ◽

Carrie Betel ◽

Kirsteen Rennie Burton ◽

Kevin McLughlin Higgins ◽

Zeina Ghorab ◽

...

Keyword(s):

Positive Predictive Value ◽

Thyroid Nodule ◽

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Lymph Node Involvement ◽

American Thyroid Association ◽

Node Involvement ◽

Benign Nodules

Introduction Thyroid ultrasound has been widely used to determine which nodules need further investigation. The goal of this study is to determine if using an ultrasonographic features checklist based on 2015 American Thyroid Association (ATA) guidelines can improve reporting and decrease unnecessary further testing. Methods In this retrospective study, ultrasonographic images of all nodules biopsied at our institution in 2014 and 2015 were reviewed by radiologists blinded to fine needle aspiration (FNA) biopsy result using a checklist. The checklist was prepared based on 2015 ATA guidelines. The ultrasonographic characteristics of thyroid nodules were compared with the result of biopsy to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for predicting malignancy. Radiologists also made an overall recommendation on need for FNA. Results A total of 425 thyroid nodule ultrasound scans were reviewed by radiologists. Biopsy results of 31 nodules were malignant and 394 were non-malignant. Malignant nodules showed higher frequency of solid composition, hypoechoechogenicity, and cervical lymph node involvement compared to benign nodules. Solid nodule composition had the highest PPV (13%) and NPV (94.7%). Extra-thyroid extension had the highest specificity (90.1%). Lesion vascularity had the highest sensitivity (83.8%), followed by hypoechogenicity (65.6%). Overall, the checklist had a positive predictive value of 9%, negative predictive value of 97.5%, sensitivity of 96.8%, and specificity of 11.14%. Radiologists determined that 10% of the nodules were very low-risk and did not require FNA. Conclusion Using a checklist based on 2015 ATA guideline thyroid nodule ultrasonographic features is a sensitive tool with high NPV to predict benign thyroid nodule, thereby preventing unnecessary FNAs.

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THE RISK OF THYROID CANCER IN PATIENTS WITH THYROID NODULE 3 CM OR LARGER

Endocrine Practice ◽

10.4158/ep-2020-0136 ◽

2020 ◽

Vol 26 (11) ◽

pp. 1286-1290

Author(s):

Edy Kornelius ◽

Shih-Chang Lo ◽

Chien-Ning Huang ◽

Yi-Sun Yang

Keyword(s):

Thyroid Cancer ◽

Positive Predictive Value ◽

Thyroid Carcinoma ◽

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Fine Needle

Objective: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk. Abbreviations: ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; mPTC = micropapillary thyroid carcinoma; NPV = negative predictive value; PPV = positive predictive value; PTC = papillary thyroid carcinoma

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Comparison of Elastographic Strain Index and Thyroid Fine-Needle Aspiration Cytology in 631 Thyroid Nodules

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-2672 ◽

2013 ◽

Vol 98 (12) ◽

pp. 4790-4797 ◽

Cited By ~ 24

Author(s):

Flavia Magri ◽

Spyridon Chytiris ◽

Valentina Capelli ◽

Margherita Gaiti ◽

Francesca Zerbini ◽

...

Keyword(s):

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Strain Index ◽

Fine Needle ◽

Needle Aspiration Cytology

Context: Ultrasound (US) elastography (USE) was recently been reported as a sensitive, noninvasive tool for identifying thyroid cancer. However, the accuracy of this technique is hampered by the intra- and interoperator variability, some US features of the nodule, and the coexistence of autoimmune thyroid disease (ATD). Objectives: The purpose of this article was to assess the accuracy of USE findings in the differential diagnosis of thyroid nodules compared with other US features to evaluate its feasibility in the presence of ATDs and identify the strain index (SI) cutoff with the highest diagnostic performance. Design: We evaluated 528 consecutive patients for a total of 661 thyroid nodules. All nodules underwent fine-needle aspiration cytology (FNAC) and USE evaluation. The SI was calculated as a ratio of the nodule strain divided by the strain of the softest part of the surrounding normal tissue. Results: The median SI value was significantly higher in THY4 and THY5 than in THY2 nodules in ATD-positive, ATD-negative, and ATD-unknown patients. The cutoff of SI for malignancy was estimated to be 2.905 by receiver operating characteristic curve analysis in a screening set (379 FNAC results), and then tested in a replication set (252 FNAC results). In all cases, a SI value of ≥2.905 conferred to the nodule a significantly greater probability of being malignant. This SI cutoff had the greatest area under the curve, sensitivity, and negative predictive value, compared with the conventional US features of malignancy. Conclusion: The elastographic SI has a high sensitivity, specificity, and negative predictive value for the diagnosis of thyroid malignancy both in the presence and in the absence of ATD. If our data on USE are also confirmed in THY3 nodules, FNAC could be avoided in a number of thyroid nodules with certain features.

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Accuracy of Fine Needle Aspiration Biopsy in Diagnosing Parotid Gland Malignancy

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v31i2.229 ◽

2016 ◽

Vol 31 (2) ◽

pp. 24-26

Author(s):

Kathleen Joy B. Santiago ◽

Rodante A. Roldan ◽

Samantha S. Castañeda

Keyword(s):

Positive Predictive Value ◽

Parotid Gland ◽

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Sensitivity Specificity

Objective: To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution. Methods: Design: Retrospective Chart Review Setting: Tertiary Government Hospital Participants: Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. Results: The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%. Conclusion: FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretion of FNAB in our institution. Keywords: Parotid neoplasm, Cancer of the parotid, fine needle aspiration biopsy, sensitivity, specificity, accuracy

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ROLE OF HYSTEROSALPINGOGRAPHY IN MANAGEMENT OF FEMALE INFERTILITY AND ITS LAPAROSCOPIC CORRELATION

10.36106/ijar/2400835 ◽

2019 ◽

pp. 1-2

Author(s):

(prof.) Alka Agrawal

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Uterine Cavity ◽

Fallopian Tubes ◽

Radiographic Technique ◽

Invasive Techniques ◽

Work Up ◽

Tubal Pathology

BACKGROUND : Infertility nowadays has become a medical as well as social problem.Laboratory findings alone is inconclusive in diagnosing infertility.HSG is the radiographic technique for evaluation of uterine cavity & fallopian tubes..Direct visualization of abdominal and pelvic organs in laparoscopy allows a definite diagnosis where clinical examination & less invasive techniques such as ultrasound & HSG fail to identify the abnormality. AIMS & OBJECTIVES :To determine the role of HSG in the evaluation of infertility & to correlate its findings with laparoscopy. METHODS : 75 infertile females aged between 20-40 years were included. HSG & laparoscopy was performed in all patients & findings were analysed. RESULTS : Sensitivity of HSG was 80 %,specificity was 76 % with positive predictive value 63%, negative predictive value 88 % in detecting tubal pathology. Sensitivity of HSG in detecting uterine pathology was 67%, specificity 73%, positive predictive value 39% and negative predictive value 89%. CONCLUSION : HSG has reasonably good sensitivity & specificity in diagnosing tubal & uerine pathology while laparoscopy has diagnostic as well as therapeutic approach.Hence they are complimentary to each other in infertility work up.

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Ultrasound and guided fine needle aspiration cytology in the submandibular triangle

South African Journal of Radiology ◽

10.4102/sajr.v2i3.1637 ◽

1997 ◽

Vol 2 (3) ◽

pp. 8-13

Author(s):

A. T. Ahuja ◽

W. T. Yang ◽

W. King ◽

C. Metreweli

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Relevant Information ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Objective: The aim of this study was to evaluate whether High Resolution Ultrasound (US) along with Fine Needle Aspiration Cytology (FNAC) can provide the surgeon with adequate preoperative information for masses in the submandibular triangle.Subjects and methods: Eighty-two consecutive patients with suspected masses of the submandibular triangle had US with guided FNAC (49 patients) and final histological correlation (47 patients).Results: Compared to final histology, US had a sensitivity of 97%, specificity 83%, positive predictive value 91% and a negative predictive value of 95% while FNAC had sensitivity of 100%, specificity 90%, positive predictive value 94% and negative predictive value of 100%.Conclusion: US combined with a FNAC is an ideal initial investigation for evaluating masses in submandibular area. It is quick, inexpensive, easily available, and provides the surgeon with relevant information preoperatively obviating the need for further expensive imaging.

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AIBx, artificial intelligence model to risk stratify thyroid nodules

10.1101/2021.02.13.21251688 ◽

2021 ◽

Author(s):

Johnson Thomas ◽

Tracy Haertling

Keyword(s):

Artificial Intelligence ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Classification Systems ◽

Image Similarity ◽

Ultrasound Images ◽

Similarity Model ◽

Sensitivity Specificity

AbstractBackgroundCurrent classification systems for thyroid nodules are very subjective. Artificial intelligence (AI) algorithms have been used to decrease subjectivity in medical image interpretation. 1 out of 2 women over the age of 50 may have a thyroid nodule and at present the only way to exclude malignancy is through invasive procedures. Hence, there exists a need for noninvasive objective classification of thyroid nodules. Some cancers have benign appearance on ultrasonogram. Hence, we decided to create an image similarity algorithm rather than image classification algorithm.MethodsUltrasound images of thyroid nodules from patients who underwent either biopsy or thyroid surgery from February of 2012 through February of 2017 in our institution were used to create AI models. Nodules were excluded if there was no definitive diagnosis of benignity or malignancy. 482 nodules met the inclusion criteria and all available images from these nodules were used to create the AI models. Later, these AI models were used to test 103 thyroid nodules which underwent biopsy or surgery from March of 2017 through July of 2018.ResultsNegative predictive value of the image similarity model was 93.2%. Sensitivity, specificity, positive predictive value and accuracy of the model was 87.8%, 78.5%, 65.9% and 81.5% respectively.ConclusionWhen compared to published results of ACR TIRADS and ATA classification system, our image similarity model had comparable negative predictive value with better sensitivity specificity and positive predictive value. By using image similarity AI models, we can eliminate subjectivity and decrease the number of unnecessary biopsies. Using image similarity AI model, we were able to create an explainable AI model which increases physician’s confidence in the predictions.

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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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Endoscopic ultrasound-guided fine needle aspiration cytology in the mediastinum

Orvosi Hetilap ◽

10.1556/oh.2013.29556 ◽

2013 ◽

Vol 154 (9) ◽

pp. 338-344 ◽

Cited By ~ 1

Author(s):

Zsolt Dubravcsik ◽

Péter Serényi ◽

László Madácsy ◽

Attila Szepes

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Needle Aspiration ◽

Safe Procedure ◽

Benign Lesions ◽

Ultrasound Guided ◽

Fine Needle

Introduction: Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients. Aim: To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literatue. Patients and methods: The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory. Results: The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis. Discussion: Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results. Orv. Hetil., 2013, 154, 338–344.

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Comparative Analysis of Diagnostic Value for Shear Wave Elastography and Real-Time Elastographic Imaging for Thyroid Nodules

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2019.2594 ◽

2019 ◽

Vol 9 (2) ◽

pp. 334-338

Author(s):

Qing Yang ◽

Wenhong Zhou ◽

Jiyu Li ◽

Guojun Wu ◽

Feng Ding ◽

...

Keyword(s):

Differential Diagnosis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Shear Wave ◽

Predictive Value ◽

Thyroid Nodules ◽

Shear Wave Elastography ◽

Roc Curves ◽

Diagnostic Value ◽

Sensitivity Specificity

Objective: To compare the diagnostic value of shear wave elastography (SWE) and real-time elastography (RTE) in the diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients who ever received thyroidectomy in our hospital from January 2016 to January 2018 were identified. Meanwhile, all the patients received SWE and RTE before surgery, and all the diagnoses were confirmed by pathological examinations. With respect to SWE technique, the Subject Operating Characteristics (ROC) curves were drawn, in order to obtain the optimal threshold and then make differential diagnoses of benign and malignant thyroid nodules. In terms of RTE, the Rago 5 scoring method was utilized to make differential diagnoses of benign and malignant thyroid nodules. Besides, the pathological examinations after surgery could be considered as the golden standard. At last, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and RTE were calculated, respectively. Results: A total of 51 thyroid nodules were identified, and 41 nodules were benign, 10 nodules were malignant. On the basis of ROC curves, with respect to SWE, the best threshold for differential diagnosis of benign and malignant thyroid nodules is 38.3 kPa. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE were 72.7% (8/11), 85% (34/40), 82.4% (42/51), 68.4% (13/19), and 87.5% (35/40), respectively. And the diagnostic indicators of RTE were 81.8% (9/11), 87.5% (35/40), 84.3% (43/51), 73.7% (14/19), and 90.0% (36/40). The sensitivity of quasi-static elastography in differential diagnosis of benign and malignant thyroid nodules with diameter ≤1 cm was 87.5% (7/8), and the sensitivity of SWE was 50.0% (5/10). In addition, the accuracy of SWE in differential diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm was 100% (6/6), and the accuracy of RTE for this kind of thyroid nodules was 66.7% (4/6). Conclusion: Both SWE and RTE technology have good application value in differential diagnosis of benign and malignant thyroid nodules. But, SWE is preferable when making diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm, and RTE was superior in detecting benign and malignant thyroid nodules with diameter ≤1 cm.

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