scholarly journals Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

Endocrines ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 91-98
Author(s):  
Maria I. Linares Linares Valderrama ◽  
Marilyn A. Arosemena ◽  
Anu Thekkumkattil ◽  
Russ A. Kuker ◽  
Rosa P. Castillo ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Clinical Data ◽  
Lower Risk ◽  
Thyroid Nodules ◽  
Observer Variation ◽  
Substantial Agreement ◽  
Perfect Agreement ◽  
Ultrasound Findings ◽  
Majority Consensus ◽  
Indeterminate Cytology

Background: Substantial inter-observer variation has been documented in the recognition and description of specific sonographic features as well as for ATA sonographic risk (ASR). This raises the question if the risk stratification proposed by the ATA guidelines is reproducible and applicable for nodules with indeterminate cytology. The aim of the study was to determine the inter-reader agreement (IRR) among radiologists using the 2015 ASR stratification in indeterminate thyroid nodules. Methods: Three board certified radiologists who were blinded to clinical data and to each other, interpreted the ultrasound findings of 179 nodules that had Bethesda III cytology. The nodules were classified into high suspicion (HS), intermediate (IS), low (LS), very low (VLS). Echogenicity, composition, shape taller than wide, vascularity, type of margins, presence and type of calcifications were also described. Results: The majority consensus revealed that 28%, 27%, 39% and 5% were described as high, intermediate, low and very low ASR, respectively. The inter-reader agreement was near perfect (k 0.82 CI 95% (0.77–0.87)). Nodules were paired into a higher risk (HS + IS) and lower risk (LS + VLS) categories with substantial agreement (k 0.7) in both categories. Conclusion: A near perfect agreement among readers was observed when stratifying indeterminate cytology nodules for ASR.

scholarly journals Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification

Endocrine ◽  
2019 ◽  
Vol 66 (2) ◽  
pp. 278-287 ◽  
Author(s):  
Cesar A. Lam ◽  
Melissa J. McGettigan ◽  
Zachary J. Thompson ◽  
Laila Khazai ◽  
Christine H. Chung ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Observer Agreement ◽  
Indeterminate Cytology

scholarly journals Thyroid Nodules with Indeterminate Cytology: Utility of the American Thyroid Association Sonographic Patterns for Cancer Risk Stratification

Thyroid ◽  
2018 ◽  
Vol 28 (8) ◽  
pp. 1004-1012 ◽  
Author(s):  
Pablo Valderrabano ◽  
Melissa J. McGettigan ◽  
Cesar A. Lam ◽  
Laila Khazai ◽  
Zachary J. Thompson ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
American Thyroid Association ◽  
Sonographic Patterns ◽  
Indeterminate Cytology

scholarly journals A Novel Risk Stratification System for Thyroid Nodules With Indeterminate Cytology—A Pilot Cohort Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Cristiane J. Gomes-Lima ◽  
Sungyoung Auh ◽  
Shilpa Thakur ◽  
Marina Zemskova ◽  
Craig Cochran ◽  
...  
Keyword(s):  
Cohort Study ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Stratification System ◽  
Indeterminate Cytology ◽  
Risk Stratification System

scholarly journals OR27-3 A Novel Risk Stratification System for Thyroid Nodules with Indeterminate Cytology: A Pilot Cohort Study

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Cristiane Gomes-Lima ◽  
Sungyoung Auh ◽  
Shilpa Thakur ◽  
Marina Zemskova ◽  
Craig Cochran ◽  
...  
Keyword(s):  
Cohort Study ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Stratification System ◽  
Indeterminate Cytology ◽  
Risk Stratification System

scholarly journals Evaluation and Management of Indeterminate Thyroid Nodules

2017 ◽  
Vol 24 (5) ◽  
pp. 107327481772923 ◽  
Author(s):  
Pablo Valderrabano ◽  
Bryan McIver
Keyword(s):  
Molecular Markers ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Clinical Information ◽  
Added Value ◽  
Current Evidence ◽  
Management Decision ◽  
National Guidelines ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology. Several factors can be used to stratify the risk of malignancy in thyroid nodules with indeterminate cytology. Male gender, large tumors (>4 cm), suspicious sonographic patterns, and the presence of nuclear atypia on the cytology are all associated with an increased cancer prevalence. The added value of current molecular markers in the risk stratification process needs further study because their performance seems compromised in some clinical settings and remains to be validated in others. Risk stratification is possible in thyroid nodules with indeterminate cytology using data that are often underused by current guidelines. Future guidelines should integrate these factors and personalize the recommended diagnostic and therapeutic approaches accordingly.

scholarly journals Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

2022 ◽  
Author(s):  
Yinghe Lin ◽  
Shuiqing Lai ◽  
Peiqing Wang ◽  
Jinlian Li ◽  
Zhijiang Chen ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Area Under The Curve ◽  
Thyroid Neoplasms ◽  
Malignancy Risk ◽  
Follicular Thyroid Adenoma ◽  
Ultrasound Findings ◽  
Low Efficiency ◽  
Stratification System ◽  
Determining The Indication

Abstract Objectives To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy. Methods Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system. Results The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511–0.611). The missed biopsy rates were 9.0–22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2–4 cm were 16.2–35.1% and 0–20.0%, respectively. Unnecessary biopsy rates were 65.3–93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2–89.7%. Conclusion The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms. Key Points • Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

scholarly journals Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems

Endocrines ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 102-118
Author(s):  
Stefania Giuliano ◽  
Maria Mirabelli ◽  
Eusebio Chiefari ◽  
Margherita Vergine ◽  
Rita Gervasi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Clinical Features ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Indeterminate Cytology

The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter >5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p < 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters >5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.

Abstract #564 Advanced Ultrasound Application- Impact on Presurgical Risk Stratification of Thyroid Nodules

2019 ◽  
Vol 25 ◽  
pp. 287
Author(s):  
Andreea Borlea ◽  
Dana Stoian ◽  
Adrian Apostol ◽  
Mihnea Derban ◽  
Laura Cotoi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Ultrasound Application

Abstract #1221 Real World Experience with Thyroseq V3 Genomic Classifier in Thyroid Nodules with Indeterminate Cytology: Results of Testing of the First 3,783 Consecutive Samples

2018 ◽  
Vol 24 ◽  
pp. 316
Author(s):  
Yuri Nikiforov ◽  
Steven P. Hodak ◽  
Susan Mandel ◽  
Zubair Baloch ◽  
Daniel Kuriloff ◽  
...  
Keyword(s):  
Real World ◽  
Thyroid Nodules ◽  
Indeterminate Cytology

The incidentaloma of the thyroid

2005 ◽  
Vol 44 (05) ◽  
pp. 213-224
Author(s):  
C. Kobe ◽  
M. Schmidt ◽  
H. Schicha ◽  
M. Dietlein
Keyword(s):  
Risk Stratification ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Outcome Measurement ◽  
Needle Aspiration ◽  
Epidemiological Studies ◽  
Fine Needle ◽  
Small Cancer ◽  
The Family ◽  
Wait And See

Summary:The incidentally detected thyroid nodule using sonography is described as incidentaloma; the most nodules have a diameter up to 1.5 cm. Sonography will detect thyroid nodules in more than 20% of the population in Germany. Epidemiological studies investigating the prevalence of malignancy in such incidentalomas are missing. The incidence of differentiated thyroid cancer is about 3 per 100,000 people and year. However, several monocentric studies have shown a prevalence of malignancy of up to 10% of the thyroid nodules in selected patients’ group. The histology did not found microcarcinomas only, but also small cancer with infiltration of the thyroid capsule, lymph node metastasis or multifocal spread. The studies were not designed for outcome measurement after early and incidental detection of small thyroid cancers. Hypoechogenity, ill defined borders, central hypervascularization or microcalcifications were used as combined criteria for risk stratification. The second method for risk stratification is scintigraphy and further tests are warranted for hypofunctioning nodule ≥1 cm. Additionally, the family history, patient’s age <20 years, former radiation of the neck, and measurement of calcitonin should be regarded. Without such a risk stratification selection for fine needle aspiration is impossible. Fine needle aspiration of non-palpable incidentalomas led to non-representative or unequivocal cytological findings in up to 40%. Because better outcome of incidentally detected small thyroid carcinomas is not proved and because sonography, scintigraphy and fine needle aspiration remain imprecise regarding dignity of incidentalomas, fine needle aspiration is not the standard for small, non-palpable thyroid nodules. Conclusion: For management of incidentaloma, sonographically unsuspicious, scintigraphically indifferent (nodules ≥1 cm) and without any risk factors in patients’ history, wait and see is justified when patient is informed about the problem.

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