Indeterminate Thyroid Nodules With RAS Mutations Have Higher Rates of Malignancy When Multiple Non-Cystic Nodules or Irregular Borders Are Present

Abstract Background: There is heterogeneity in positive predictive value for cancer in RAS-mutated cytologically indeterminate nodules and paucity of data with regards to specific ultrasound features that are associated with malignancy in these nodules. The goal of this study is to assess the ultrasonographic characteristics, in relation to clinical and histopathologic outcomes of thyroid nodules known to have a RAS mutation. Design and Methods: Cases were identified using our institutional Afirma® Genetic Sequence Classifier (GSC) database, and a retrospective review of electronic medical records for thyroid nodules biopsied between January 2018 and August 2020. Nodules categorized as Bethesda III or IV and harboring a RAS mutation by Xpression Atlas® were included. Thyroid ultrasound images were reviewed by the authors and were risk stratified according to the 2015 American Thyroid Association Thyroid Nodule and Differentiated Thyroid Cancer Guidelines (ATA Guidelines) and the 2017 ACR TIRADS system (ACR Guidelines). The nodules were divided into benign or malignant categories based on surgical pathology. Noninvasive follicular thyroid neoplasms with papillary like nuclear features (NIFTP) were categorized as benign. Results: A total of 22 nodules were identified to have a RAS mutation. NRAS mutated nodules, all with the same point mutation (pQ61R c.182A>G), were most common 14/22 (63.6%). There was no significant difference in clinical features, ultrasonographic appearance or histopathologic outcomes between NRAS- and HRAS-mutated nodules. 12/22 (54.4%) were low risk by ATA Guidelines and 11/22 (50%) were TIRADS 4 (moderately suspicious) by ACR Guidelines. There was no significant difference in predictive value of ATA Guidelines vs ACR Guidelines. The prevalence of malignancy was 45.4% (only slightly lower than the general risk for a suspicious GSC). Invasive follicular variant papillary thyroid cancer (FVPTC), was the most common malignancy, 4/10 (40%). 6/10 (60%) were classified as low risk of recurrence post-operatively. All malignant RAS-mutated nodules (10/10) had at least one other non-cystic nodule present on ultrasonography whereas only 4/9 (44%) of RAS-mutated benign nodules did [P=.006]. RAS-mutated malignant nodules had significantly more nodules with irregular borders compared to RAS-mutated benign nodules (4/10 and 0/10, 40% and 0% respectively) [P=.03]. Conclusions: This is the first study to observe higher rates of malignancy in RAS-mutated indeterminate nodules when other non-cystic nodules are present. A lobectomy is the preferred surgical approach for RAS-mutated nodules, however a total thyroidectomy may be considered in patients with other non-cystic nodules or irregular nodules borders. Overall, RAS-mutated nodules have a low risk of recurrence post-operatively.

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Differences of US-FNA BSRTC class, postoperative pathology, and mutation landscape of thyroid nodules between China and other countries.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3055 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3055-3055

Author(s):

Yuntao Song ◽

Jie Liu ◽

Weiran Wang ◽

Tonghui Ma

Keyword(s):

United States ◽

Thyroid Cancer ◽

Thyroid Nodules ◽

Malignant Tumors ◽

The United States ◽

Braf V600e ◽

Class V ◽

Ras Mutation ◽

First Choice ◽

Significant Difference

3055 Background: Ultrasound and ultrasound-guided fine needle aspiration (US-FNA) are the first choice for judging benign and malignant thyroid nodules. This study will report on the differences of US-FNA BSRTC class, postoperative pathology and mutation landscape of thyroid nodules between China and other countries. Methods: We conducted a prospective study containing 383 FNA samples of thyroid nodules. For most of these FNA samples, genomic DNA and RNA were extracted and sequenced with FSZ-Thyroid NGS Panel V1, and postoperative pathology were followed up. Moreover, we also compared results of this study with those of West China Hospital in China, Yamashita Thyroid Hospital in Japan, and Cleveland Clinic in the United States. Results: Among the 383 FNA samples, the proportions of BSRTC class I to VI were 10.7%, 6.3%, 18.8%, 3.7%, 12.3%, and 48.3% respectively. Compared with study in other countries, the proportion of class II was significantly lower than that in Japan and the United States. Meanwhile, the proportion of class V and VI were significantly higher than the above two countries. Subsequently, 232 thyroid nodules were surgically removed. Postoperative pathology showed that the proportion of malignant tumors (85.3%) was also significantly higher than reported in Japan and the United States. But compared with other studies in China, there was no significant difference. Most of the malignant tumors were papillary thyroid cancer (PTC, 96%), accompanied with 2 follicular thyroid cancer (FTC), 3 medullary cancer (MTC) and 3 anaplastic thyroid cancer (ATC). Compared with study in the United States, the proportion of PTC and FTC were elevated (96% vs. 85.3%) and reduced (1% vs. 9.3%) respectively. At last, we also analysis the mutation landscape of 180 malignant tumors. Compared with TCGA study, the frequency of BRAF V600E in PTC in our study was significantly higher than that of TCGA (73.3% vs. 58%), and the frequency of RAS mutation was significantly lower (1.2% vs. 12.6%). And compared with an institutional experience of ThyroSeq v3 for Bethesda III and IV at the University of Pittsburgh Medical Center, the frequency of BRAF V600E and RAS mutation in Bethesda III-IV malignant tumors was also significantly higher (45.8% vs. 1.4%) and lower (8.3% vs. 47.1%). Conclusions: There were significant differences in BSRTC class and postoperative pathology between China and other countries, such as Japan and the United States. The possible reasons included that the indications for FNA in China were different. For example, most of patients who underwent FNA in this study had suspicious clinical/ultrasound features. So the proportion of BSRTC class V and VI as well as the malignant rate were elevated. On the other hand, more BRAF V600E and less RAS mutations were detected in malignant tumors in this study which might result from racial differentiation and discrepancy in proportion of PTC and FTC.

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Real-world Comparison of Afirma GEC and GSC for the Assessment of Cytologically Indeterminate Thyroid Nodules

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz099 ◽

2019 ◽

Vol 105 (3) ◽

pp. e428-e435 ◽

Cited By ~ 12

Author(s):

Vicente T San Martin ◽

Lima Lawrence ◽

James Bena ◽

Nabil Z Madhun ◽

Eren Berber ◽

...

Keyword(s):

Test Performance ◽

Predictive Value ◽

Preoperative Diagnosis ◽

Thyroid Nodules ◽

Gene Sequencing ◽

Surgical Excision ◽

Molecular Tests ◽

Academic Center ◽

Indeterminate Nodules ◽

Benign Nodules

Abstract Context Molecular tests have improved the accuracy of preoperative diagnosis of indeterminate thyroid nodules. The Afirma Gene Sequencing Classifier (GSC) was developed to improve the specificity of the Gene Expression Classifier (GEC). Independent studies are needed to assess the performance of GSC. Objective The aim was to compare the performance of GEC and GSC in the assessment of indeterminate nodules. Design, Settings, and Participants Retrospective analysis of Bethesda III and IV nodules tested with GEC or GSC in an academic center between December 2011 and September 2018. Benign call rates (BCRs) and surgical outcomes were compared. Histopathologic data were collected on nodules that were surgically resected to calculate measures of test performance. Results The BCR was 41% (73/178) for GEC and 67.8% (82/121) for GSC (P < .001). Among specimens with dominant Hürthle cell cytology, the BCR was 22% (6/27) for GEC and 63.2% (12/19) for GSC (P = .005). The overall surgery rate decreased from 47.8% in the GEC group to 34.7% in the GSC group (P = .025). One GEC-benign and 3 GSC-benign nodules proved to be malignant on surgical excision. GSC had a statistically significant higher specificity (94% vs 60%, P < .001) and positive predictive value (PPV) (85.3% vs 40%, P < .001) than GEC. While sensitivity and negative predictive value (NPV) dropped with GSC (97.0% vs 90.6% and 98.6% vs 96.3%, respectively), these differences were not significant. Conclusions GSC reclassified more indeterminate nodules as benign and improved the specificity and PPV of the test. These enhancements appear to be resulting in fewer diagnostic surgeries.

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Change in Practice of Radioactive Iodine Administration in Differentiated Thyroid Cancer: A Single-Centre Experience

European Thyroid Journal ◽

10.1159/000516358 ◽

2021 ◽

pp. 1-8

Author(s):

Ayanthi Wijewardene ◽

Matti Gild ◽

Carolina Nylén ◽

Geoffrey Schembri ◽

Paul Roach ◽

...

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Adjuvant Therapy ◽

Radioactive Iodine ◽

Temporal Trends ◽

Low Risk ◽

American Thyroid Association ◽

Risk Of Recurrence ◽

Increased Risk ◽

Risk Patients

Objective: Our study aimed to analyse temporal trends in radioactive iodine (RAI) treatment for thyroid cancer over the past decade; to analyse key factors associated with clinical decisions in RAI dosing; and to confirm lower activities of RAI for low-risk patients were not associated with an increased risk of recurrence. Methods: Retrospective analysis of 1,323 patients who received RAI at a quaternary centre in Australia between 2008 and 2018 was performed. Prospectively collected data included age, gender, histology, and American Joint Committee on Cancer stage (7th ed). American Thyroid Association risk was calculated retrospectively. Results: The median activities of RAI administered to low-risk patients decreased from 3.85 GBq (104 mCi) in 2008–2016 to 2.0 GBq (54 mCi) in 2017–2018. The principal driver of this change was an increased use of 1 GBq (27 mCi) from 1.3% of prescriptions in 2008–2011 to 18.5% in 2017–2018. In patients assigned as low risk per ATA stratification, lower activities of 1 GBq or 2 GBq (27 mCi or 54 mCi) were not associated with an increased risk of recurrence. In patients assigned to intermediate- or high-risk categories who received RAI as adjuvant therapy, there was no difference in risk of recurrence between 4 GBq (108 mCi) and 6 GBq (162 mCi). Conclusions: Our data demonstrate an evolution of RAI activities consistent with translation of ATA guidelines into clinical practice. Use of lower RAI activities was not associated with an increase in recurrence in low-risk thyroid cancer patients. Our data also suggest lower RAI activities may be as efficacious for adjuvant therapy in intermediate- and high-risk patients.

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Can We Safely Reduce the Administration of 131-iodine in Patients With Differentiated Thyroid Cancer? – Experience of the Brugmann Hospital in Brussels

10.21203/rs.3.rs-39339/v1 ◽

2020 ◽

Author(s):

Laura Iconaru ◽

Felicia Baleanu ◽

Georgiana Taujan ◽

Ruth Duttmann ◽

Linda Spinato ◽

...

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Differentiated Thyroid Cancer ◽

Low Risk ◽

Response To Treatment ◽

American Thyroid Association ◽

Risk Of Recurrence ◽

Risk Patients ◽

Group 2 ◽

Group 1

Abstract Background131-iodine administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk.The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence.MethodsPatients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to iodine administration, cumulative administered 131I activity and response to treatment. ResultsIn total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5% and 48.3% as intermediate risk and 19.2% and 20.7% as high risk (P=0.38). Preparation to iodine administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 97.4% in Group 2 (p<0.001). 131-iodine was administered to 47/78 patients (60%) in Group 1 (5 at low risk of recurrence) and 39/58 patients (67%) in Group 2 (0 with a low risk). Among the treated patients, median 131I cumulative activity was significantly higher in Group 1 (3.70GBq [100mCi] range 1.11-20.35 GBq [30-550 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11-11.1 GBq [30-300 mCi], P<0.001. Complete response was found in 89.7% in Group 1 vs. 94.8% in Group 2 (P=0.52). ConclusionsUsing the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and an almost systematic use of rhTSH stimulation before radioiodine therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.

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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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MON-525 ATA and ACR TIRADS Classification Systems as Additional Predictors of Malignancy in Afirma GSC Suspicious Thyroid Nodules

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.316 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Irina Azaryan ◽

Mayumi Endo

Keyword(s):

High Risk ◽

Thyroid Nodules ◽

Medical Center ◽

Academic Medical Center ◽

Classification Systems ◽

Low Risk ◽

Surgical Pathology ◽

Molecular Testing ◽

American Thyroid Association ◽

Benign Nodules

Abstract Objective: Evaluation and management of thyroid nodules with cytologically indeterminate results remain challenging in clinical practice. Despite the implementation of molecular testing in an attempt to avoid surgical intervention, diagnostic thyroidectomy still occurs due to the relatively low positive predictive value of these molecular testing. We conducted a study to analyze whether combining US characteristics and results of molecular testing would better elucidate predicting true positive results. Methods: We retrospectively reviewed thyroid ultrasound images of 172 nodules in 162 patients (mean age, 55 years +/- 14) with indeterminate cytology results (Bethesda III and IV) that underwent Afirma Gene Sequencing Classifier (GSC) testing at a single academic medical center between 2017–2019. All nodules were classified according to 2015 American Thyroid Association (ATA) and 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Results: A total of 172 with subsequent Afirma GSC molecular testing were included in the study. There were 127 nodules with Bethesda III (AUS/FLUS) (73.8%), and 45 nodules with Bethesda IV (SFN/HCN) (26.2%) results. The mean nodule volume was 5.4 +/- 10 cm3. Afirma GSC identified 129 nodules (75%) as benign and 43 nodules (25%) as suspicious. Per ATA classification, 10.4% (18) of nodules were classified as very low risk, 40.7% (70) as low risk, 36.5% (62) as intermediate and 12.8% (22) as high risk for malignancy. There was a significant association between ATA classification and Afirma benign nodules (P=0.002). All nodules were also classified per TIRADS system with the following distribution: 5 (1.16%) TIRADS 1, 7 (4%) TIRADS 2, 54 (31%) TIRADS 3, 90 (52%) TIRADS 4, and 16 (9.3%) TIRADS 5. We did not observe the similar association between TIRADS system and benign nodules as we did with ATA classification (P=0.4). 35 patients (79.5%) with Afirma suspicious results underwent surgery, of which 18 (51.4%) surgical pathology were malignant. 8 patients with Afirma suspicious results decided to proceed with ultrasound surveillance. The malignancy rates of nodules with low, intermediate and high suspicion for malignancy classified by the ATA guidelines were 44% (9 of 18), 33% (56 of 18) and 22% (4 of 18). The malignancy rates of TIRADS category 3, 4 and 5 nodules were 44% (8 of 18 nodules), 44% (8 of 18 nodules) and 11% (2 of 18 nodules). Subset analysis of surgical pathology benign and cancerous nodules did not show significant association between ATA (P=0.5) or TIRADS (P=0.4) classification systems. Conclusion: Our study showed that Afirma benign nodules were associated with a lower risk of malignancy per ATA classification but not with TIRADS system. We did not find a significant association between pathology proven cancer cases and high-risk ATA or TIRADS ultrasound classification systems.

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Analysis of Enigma Gene-Signaling Pathways in Thyroid Cancer

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1747 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A856-A856

Author(s):

Narudee Churdsuwanrak ◽

Robert Niihara ◽

Kristiana Rood ◽

Celina Yamauchi ◽

Kharl Wright ◽

...

Keyword(s):

Thyroid Cancer ◽

Protein Expression ◽

Mrna Expression ◽

Thyroid Nodules ◽

Expression Level ◽

Mrna Expression Level ◽

Indeterminate Nodules ◽

Benign Nodules ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Fine-needle aspiration (FNA) is one of the most accurate modes of obtaining thyroid nodule biopsies, however, up to 25% of biopsies still yield indeterminate results. There is an increasing number of thyroidectomies due to indeterminate nodules by FNA alone. Therefore, more accurate and time efficient diagnostic approaches for analyzing indeterminate thyroid nodules is required. Recent studies showed that Enigma is associated with different cancer types, including thyroid cancer progression and calcification through its interaction with bone morphogenic protein-1 (BMP-1) and tyrosine kinases linked to mitogen-activated protein kinase (MAPK) signaling pathway. Our published data on Enigma protein analysis with immunohistochemistry showed promising findings to discriminate malignant versus benign nodules. We also showed a thyroid cancer stage-dependent enhancement of Enigma protein expression. In this study, we are investigating Enigma at a gene expression level by quantitative reverse transcription polymerase chain reaction (RT-qPCR), which is more time-efficient, quantitative, and requires less tissue than immunohistochemistry. We extracted mRNA/DNA/proteins from fresh malignant and benign thyroid nodules using a Qiagen AllPrep DNA/RNA/Protein Mini Kit. After verification of the quantity and purity by NanoDrop, isolated mRNA was then run through Enigma-RT-qPCR. MAPK assay was done by western blotting using MAPK-antibody. Our initial results found that Enigma-mRNA expression level was 3-fold higher in malignant compared to benign thyroid tissues. This finding supports our previous protein expression data with a relative quantitative difference in Enigma-mRNA expression level between malignant and benign thyroid nodules. MAPK expression was upregulated in thyroid cancer compared to benign nodules. We conclude that Enigma-RT-qPCR can be used effectively in FNA samples derived from thyroid nodules, which could potentially enhance the diagnostic accuracy of indeterminate nodules and decrease unnecessary thyroidectomies. Furthermore, both Enigma and MAPK were highly expressed in advanced tumor in the same tissues. Future study is needed to establish the functional interaction of Enigma-MAPK activity in thyroid cancer cells.

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How Can We Apply the New American Thyroid Association Treatment Guidelines for Children and Adolescents with Thyroid Cancer to Improve Patient Management?

US Endocrinology ◽

10.17925/use.2016.12.01.39 ◽

2016 ◽

Vol 12 (01) ◽

pp. 39

Author(s):

Andrew J Bauer ◽

Gary L Francis ◽

Steven Waguespack ◽

Donald Zimmerman ◽

Sowmya Krishnan ◽

...

Keyword(s):

Thyroid Cancer ◽

Children And Adolescents ◽

Patient Management ◽

Thyroid Nodules ◽

Treatment Guidelines ◽

Disease Free Survival ◽

Low Risk ◽

American Thyroid Association ◽

Society Meeting ◽

Endocrine Society

Background:Ultrasound reveals thyroid abnormalities in 18% of children and adolescents, of which, 22% are malignant. This creates a dilemma for practitioners who must distinguish lesions that require removal (high risk for malignancy) from lesions that can be observed (low risk for malignancy). Furthermore, treatment of children with differentiated thyroid cancer (DTC) is evolving. Previous treatments were based on adult protocols prescribing total thyroidectomy, lymph node dissection, and radioactive iodine (RAI) ablation for children with DTC, regardless of disease extent. This achieved excellent disease-free survival but high, and potentially avoidable, surgical and medical complications including an increase in secondary non-thyroid malignancies.Methods:This manuscript is a synopsis of cases presented during a symposium at the 2015 Pediatric Endocrine Society meeting (San Diego, CA) with recommendations based on the American Thyroid Association (ATA) management guidelines for children and adolescents with thyroid nodules and DTC.Results:The cases were selected to demonstrate application of the guidelines across a variety of pediatric patients with DTC highlighting key points of the ATA guidelines. The cases will assist practitioners in learning how to apply these guidelines to patient management.Conclusion:Treatment of children with thyroid nodules and DTC is evolving. Current guidelines emphasize the importance of surgery by experienced teams and deferral of RAI ablation for low-risk patients.

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

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1972 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Ilana Jaye Halperin ◽

Judy Qiang

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Needle Aspiration ◽

American Thyroid Association ◽

Biopsy Result ◽

Data Set ◽

Benign Nodules ◽

Work Up

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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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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