Malignancy risk stratification of thyroid nodules with cytological diagnosis of folicular neoplasm (Bethesda IV), according to the ultrasound sonographic patterns proposed by the American Thyroid Association (ATA)

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

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Comparisons of ACR TI-RADS, ATA guidelines, Kwak TI-RADS, and KTA/KSThR guidelines in malignancy risk stratification of thyroid nodules

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-190778 ◽

2020 ◽

pp. 1-14 ◽

Cited By ~ 3

Author(s):

Wei-Bing Zhang ◽

Hui-Xiong Xu ◽

Yi-Feng Zhang ◽

Le-Hang Guo ◽

Shi-Hao Xu ◽

...

Keyword(s):

Risk Stratification ◽

Thyroid Nodules ◽

Malignancy Risk

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Malignancy risk stratification and FNA recommendations for thyroid nodules: A comparison of ACR TI-RADS, AACE/ACE/AME and ATA guidelines

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2020.102625 ◽

2020 ◽

Vol 41 (6) ◽

pp. 102625 ◽

Cited By ~ 1

Author(s):

Jian-Yun Peng ◽

Fu-Shun Pan ◽

Wei Wang ◽

Zhu Wang ◽

Quan-Yuan Shan ◽

...

Keyword(s):

Risk Stratification ◽

Thyroid Nodules ◽

Malignancy Risk

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The Role of Molecular Testing for the Indeterminate Thyroid FNA

Genes ◽

10.3390/genes10100736 ◽

2019 ◽

Vol 10 (10) ◽

pp. 736 ◽

Cited By ~ 5

Author(s):

Esther Diana Rossi ◽

Liron Pantanowitz ◽

William C. Faquin

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Adult Population ◽

Needle Aspiration ◽

Molecular Testing ◽

American Thyroid Association ◽

Cytological Diagnosis ◽

Fine Needle ◽

Thyroid Fna

Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.

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Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the “Right” TIRADS

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01674 ◽

2018 ◽

Vol 104 (1) ◽

pp. 95-102 ◽

Cited By ~ 41

Author(s):

Giorgio Grani ◽

Livia Lamartina ◽

Valeria Ascoli ◽

Daniela Bosco ◽

Marco Biffoni ◽

...

Keyword(s):

Risk Stratification ◽

Thyroid Nodules ◽

False Negative ◽

False Negative Rate ◽

Needle Aspiration ◽

Classification Systems ◽

American Thyroid Association ◽

Predictive Values ◽

Korean Society ◽

The Right

Abstract Context The prevalence of thyroid nodules in the general population is increasingly high, and at least half of those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as “rule-out” tests that can identify nodules that do not require fine-needle aspiration (FNA) cytology. Objective To comparatively assess the performances of five internationally endorsed sonographic classification systems [those of the American Thyroid Association, the American Association of Clinical Endocrinologists, the American College of Radiology (ACR), the European Thyroid Association, and the Korean Society of Thyroid Radiology] in identifying nodules whose FNAs can be safely deferred and to estimate their negative predictive values (NPVs). Design Prospective study of thyroid nodules referred for FNA. Setting Single academic referral center. Patients Four hundred seventy-seven patients (358 females, 75.2%); mean (SD) age, 55.9 (13.9) years. Main Outcome Measures Number of biopsies classified as unnecessary, false-negative rate (FNR), sensitivity, specificity, predictive values, and diagnostic ORs for each system. Results Application of the systems’ FNA criteria would have reduced the number of biopsies performed by 17.1% to 53.4%. The ACR Thyroid Imaging Reporting and Data System (TIRADS) allowed the largest reduction (268 of 502) with the lowest FNR (NPV, 97.8%; 95% CI, 95.2% to 99.2%). Except for the Korean Society of Thyroid Radiology TIRADS, all other systems exhibited significant discriminatory performance but produced significantly smaller reductions in the number of procedures. Conclusions Internationally endorsed sonographic risk stratification systems vary widely in their ability to reduce the number of unnecessary thyroid nodule FNAs. The ACR TIRADS outperformed the others, classifying more than half the biopsies as unnecessary with a FNR of 2.2%.

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Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems

European Thyroid Journal ◽

10.1159/000504219 ◽

2019 ◽

Vol 9 (2) ◽

pp. 85-91 ◽

Cited By ~ 6

Author(s):

Giorgio Grani ◽

Livia Lamartina ◽

Valeria Ramundo ◽

Rosa Falcone ◽

Cristiano Lomonaco ◽

...

Keyword(s):

Risk Stratification ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Negative Impact ◽

Lower Sensitivity ◽

Intraobserver Variability ◽

Transverse Diameter ◽

American Thyroid Association ◽

Alternative Definition ◽

The Impact

Introduction: A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. To potentially improve the reliability of the TTW definition, we propose an arbitrary ratio of ≥1.2. Objective: The aim of this study was to estimate the impact of this definition on diagnostic performance. Methods: We prospectively analyzed 553 thyroid nodules referred for cytology evaluation at an academic center. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2). Results: The alternative definition classified fewer nodules as TTW (28, 5.1% vs. 94, 17%). The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. When applied to sonographic risk stratification systems, however, the proposed definition would increase the number of avoided biopsies (up to 58.2% for ACR TIRADS) and the specificity of all systems, without negative impact on sensitivity or diagnostic odds ratio. Conclusions: Re-defining TTW nodules as those with an AP/T ratio ≥1.2 improves this marker’s specificity for malignancy. Using this definition in risk stratification systems will increase their specificity, reducing the number of suggested biopsies without significantly diminishing their overall diagnostic performance.

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