scholarly journals Malignancy Risk Stratification of Thyroid Nodules According to Echotexture and Degree of Hypoechogenicity: A Multicenter Validation Study

2022 ◽  
Author(s):  
Ji Ye Lee ◽  
Chang Yoon Lee ◽  
Inpyeong Hwang ◽  
Sung-Hye You ◽  
Sun-Won Park ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Validation Study ◽  
Thyroid Nodules ◽  
Malignancy Risk ◽  
Significant Difference ◽  
The Us ◽  
Multicenter Validation

Abstract Purpose Various risk stratification systems show some discrepancies in the ultrasound (US) lexicon of nodule echotexture and hypoechogenicity. This study aimed to determine the malignancy risk of thyroid nodules according to their echotexture and degree of hypoechogenicity in a multicenter dataset.Methods From June to September 2015, 5,601 thyroid nodules (≥ 1.0 cm) in 4,989 consecutive patients who underwent thyroid US and with a final diagnoses from 26 institutions were evaluated. Thyroid nodules were stratified according to the US echotexture (homogeneous vs. heterogeneous) and degree of hypoechogenicity (mild, moderate, or marked). We then calculated malignancy risk and compared four subgroups stratified with nodule composition and presence of suspicious features.Results Heterogeneous hypoechoic nodules showed a significantly higher malignancy risk than heterogeneous isoechoic nodules (P ≤ 0.017) except in partially cystic nodules. There was no significant difference in malignancy risk between homogeneous vs. heterogeneous hypoechoic nodules (P ≥ 0.086) and between homogeneous vs. heterogeneous iso- or hyperechoic nodules (P ≥ 0.05) except in partially cystic nodules without suspicious features. The malignancy risks of both homogeneous and heterogeneous iso- or hyperechoic nodules were low to intermediate, depending on the presence of suspicious features. Regarding the degree of hypoechogenicity, there was no significant difference in malignancy risk between markedly and moderately hypoechoic nodules in all subgroups (P ≥ 0.48). Marked or moderately hypoechoic nodules showed a significantly higher risk than mild hypoechoic (P ≤ 0.016) and iso- or hyperechoic (P < .001) nodules. Conclusions The predominant echogenicity effectively stratifies the malignancy risk of nodules with heterogeneous echotexture. For malignancy risk stratification, the degree of nodules’ hypoechogenicity could be grouped as mild vs. moderate to marked hypoechogenicity.

Impact of the ultrasonography assessment method on the malignancy risk and diagnostic performance of five risk stratification systems in thyroid nodules

2021 ◽  
Author(s):  
Go Eun Yang ◽  
Dong Gyu Na
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Assessment Method ◽  
Malignant Tumours ◽  
Malignancy Risk ◽  
Significant Difference ◽  
Estimated Risk ◽  
The Impact

Abstract Purpose Ultrasonographic (US) assessment methods may affect the estimated malignancy risk of thyroid nodules. This study aimed to investigate the impact of retrospective and prospective US assessments on the estimated malignancy risk of US features, classified categories, and diagnostic performance of five risk stratification systems (RSSs) in thyroid nodules. Methods A total of 3685 consecutive thyroid nodules (≥ 1 cm) with final diagnoses (retrospective dataset, n = 2180; prospective dataset, n = 1505) were included in this study. We compared the estimated malignancy risk of US features, classified categories, and diagnostic performances of the five common RSSs between retrospective (static US images without cine clips) and prospective datasets of real-time US assessment. Results There was no significant difference in the prevalence and histological type of malignant tumours between the two datasets (p ≥ 0.216). The malignancy risk of solid composition and nonparallel orientation was higher and that of microcalcification was lower in the prospective dataset than in the retrospective dataset (p < 0.001, p = 0.018, p = 0.007, respectively). The retrospective US assessment overestimated the malignancy risk of intermediate-or high-risk nodules according to the RSSs. Prospective US assessment showed lower specificities and higher unnecessary biopsy rates by all RSSs compared to the retrospective US assessment (p ≤ 0.006, p ≤ 0.045, respectively). Conclusions The overestimated malignancy risk of microcalcification by retrospective US assessment mainly affected the estimated risk of classified categories by RSSs. The retrospective US assessment overestimated the specificities and underestimated the unnecessary biopsy rates by all RSSs.

scholarly journals European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS

2017 ◽  
Vol 6 (5) ◽  
pp. 225-237 ◽  
Author(s):  
Gilles Russ ◽  
Steen J. Bonnema ◽  
Murat Faik Erdogan ◽  
Cosimo Durante ◽  
Rose Ngu ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Malignancy Risk ◽  
The Eu

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

2020 ◽  
Vol 41 (6) ◽  
pp. 102625 ◽  
Author(s):  
Jian-Yun Peng ◽  
Fu-Shun Pan ◽  
Wei Wang ◽  
Zhu Wang ◽  
Quan-Yuan Shan ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Malignancy Risk

Improved Risk Stratification of Patients With Brugada Syndrome by the New Japanese Circulation Society Guideline　― A Multicenter Validation Study ―

2020 ◽  
Vol 84 (12) ◽  
pp. 2158-2165 ◽  
Author(s):  
Akinori Wakamiya ◽  
Tsukasa Kamakura ◽  
Tetsuji Shinohara ◽  
Kenji Yodogawa ◽  
Nobuyuki Murakoshi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Validation Study ◽  
Brugada Syndrome ◽  
Multicenter Validation ◽  
Society Guideline

scholarly journals Combination of ultrasound and molecular testing in malignancy risk estimate of Bethesda category IV thyroid nodules: results from a single-institution prospective study

2021 ◽  
Author(s):  
M. Marina ◽  
M. C. Zatelli ◽  
M. Goldoni ◽  
P. Del Rio ◽  
L. Corcione ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Somatic Mutation ◽  
Thyroid Nodules ◽  
Point Mutations ◽  
Needle Aspiration ◽  
Risk Estimate ◽  
Molecular Testing ◽  
Malignancy Risk ◽  
Needle Aspiration Cytology ◽  
Codon 61

Abstract Purpose Malignancy prediction in indeterminate thyroid nodules is still challenging. We prospectively evaluated whether the combination of ultrasound (US) risk stratification and molecular testing improves the assessment of malignancy risk in Bethesda Category IV thyroid nodules. Methods Ninety-one consecutively diagnosed Bethesda Category IV thyroid nodules were prospectively evaluated before surgery by both ACR- and EU-TIRADS US risk-stratification systems and by a further US-guided fine-needle aspiration cytology (FNAC) for the following molecular testing: BRAFV600E, N-RAS codons 12/13, N-RAS codon 61, H-RAS codons 12/13, H-RAS codon 61, K-RAS codons 12/13, and K-RAS codon 61 point-mutations, as well as PAX8/PPARγ, RET/PC1, and RET/PTC 3 rearrangements. Results At histology, 37% of nodules were malignant. No significant association was found between malignancy and either EU- or ACR-TIRADS. In total, 58 somatic mutations were identified, including 3 BRAFV600E (5%), 5 N-RAS 12/13 (9%), 13 N-RAS 61 (22%), 7 H-RAS 12/13 (12%), 11 H-RAS 61 (19%), 6 K-RAS 12/13 (10%), 8 K-RAS 61 (14%) mutations and 2 RET/PTC1 (4%), 0 RET/PTC 3 (0%), 3 PAX8/PPARγ (5%) rearrangements. At least one somatic mutation was found in 28% and 44% of benign and malignant nodules, respectively, although malignancy was not statistically associated with the outcome of the mutational test. However, the combination of ACR-, but not EU-, TIRADS with the presence of at least one somatic mutation, was significantly associated with malignant histology (P = 0.03). Conclusion US risk stratification and FNAC molecular testing may synergistically contribute to improve malignancy risk estimate of Bethesda category IV thyroid nodules.

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