scholarly journals Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

2020 ◽  
Vol 9 (1) ◽  
pp. 236 ◽  
Author(s):  
Simone Schenke ◽  
Rigobert Klett ◽  
Philipp Seifert ◽  
Michael C. Kreissl ◽  
Rainer Görges ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Cohort Analysis ◽  
Medullary Carcinoma ◽  
Data Systems ◽  
Thyroid Imaging ◽  
Promising Tool ◽  
Risk Of Malignancy

Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.

scholarly journals S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules

2020 ◽  
Vol 9 (8) ◽  
pp. 2495
Author(s):  
Ewelina Szczepanek-Parulska ◽  
Kosma Wolinski ◽  
Katarzyna Dobruch-Sobczak ◽  
Patrycja Antosik ◽  
Anna Ostalowska ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Predictive Value ◽  
Mixed Models ◽  
Diagnostic Performance ◽  
Image Interpretation ◽  
Ultrasound Image ◽  
High Sensitivity ◽  
Data System ◽  
P Value ◽  
Thyroid Imaging

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1–5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect (“possibly malignant” nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.

scholarly journals CAN THE AMERICAN THYROID ASSOCIATION, K-TIRADS, AND ACR-TIRADS ULTRASOUND CLASSIFICATION SYSTEMS BE USED TO PREDICT MALIGNANCY IN BETHESDA CATEGORY IV NODULES?

2020 ◽  
Vol 26 (9) ◽  
pp. 945-952 ◽  
Author(s):  
Wei Yang ◽  
Ghaneh Fananapazir ◽  
Jennifer LaRoy ◽  
Machelle Wilson ◽  
Michael J. Campbell
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Classification Systems ◽  
Data System ◽  
Risk Category ◽  
American Thyroid Association ◽  
Thyroid Imaging ◽  
Grading Systems ◽  
Risk Of Malignancy

Objective: Management of thyroid nodules with Bethesda category III and IV cytology on fine needle aspiration (FNA) is challenging as they cannot be adequately classified as benign or malignant. Ultrasound (US) patterns have demonstrated the utility in evaluating the risk of malignancy (ROM) of Bethesda category III nodules. This study aims to evaluate the value of 3 well-established US grading systems (American Thyroid Association [ATA], Korean Thyroid Imaging Reporting and Data System [Korean-TIRADS], and The American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS]) in determining ROM in Bethesda category IV nodules. Methods: Ninety-two patients with 92 surgically resected thyroid nodules who had Bethesda category IV cytology on FNA were identified. Nodule images were retrospectively graded using the 3 systems in a blinded manner. Associations between US risk category and malignant pathology for each system were analyzed. Results: Of the 92 nodules, 56 (61%) were benign and 36 (39%) were malignant. Forty-seven per cent of ATA high risk nodules, 53% of K-TIRADS category 5 nodules, and 50% of ACR-TIRADS category 5 nodules were malignant. The ATA high-risk category had 25% sensitivity, 82% specificity, 47% positive predictive value (PPV) for malignancy. K-TIRADS category 5 had 25% sensitivity, 85% specificity, 53% PPV for malignancy. ACR-TIRADS category 5 had 25% sensitivity, 84% specificity, 50% PPV for malignancy. None of the 3 grading systems yielded a statistically significant correlation between US risk category and the ROM ( P = .30, .72, .28). Conclusion: The ATA, Korean-TIRADS, and ACR-TIRADS classification systems are not helpful in stratifying ROM in patients with Bethesda category IV nodules. Clinicians should be cautious of using ultra-sound alone when deciding between therapeutic options for patients with Bethesda category IV thyroid nodules. Abbreviations: ACR-TIRADS = The American College of Radiology Thyroid Imaging Reporting and Data System; ATA NSP = American Thyroid Association nodule sonographic patterns and risk of malignancy classification system; FN = follicular neoplasm; FNA = fine needle aspiration; FTC = follicular thyroid carcinoma; FVPTC = follicular variant of papillary thyroid carcinoma; HCC = Hurthle cell carcinoma; HCN = Hurthle cell neoplasm; K-TIRADS = Korean Thyroid Imaging Reporting and Data System; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; NPV = negative predictive value; PPV = positive predictive value; ROM = risk of malignancy; US = ultrasound

scholarly journals Ultrasound Real-Time Tissue Elastography Improves the Diagnostic Performance of the ACR Thyroid Imaging Reporting and Data System in Differentiating Malignant from Benign Thyroid Nodules: A Summary of 1525 Thyroid Nodules

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Shufang Pei ◽  
Bin Zhang ◽  
Shuzhen Cong ◽  
Juanjuan Liu ◽  
Suqing Wu ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Real Time ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Data System ◽  
Maximum Diameter ◽  
Thyroid Imaging ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid ◽  
Tissue Elastography

Background. To explore the correlation between the ultrasound elasticity score (ES) of real-time tissue elastography (RTE) and the malignant risk stratification of the Thyroid Imaging Reporting and Data System (TI-RADS) and to evaluate the added value of RTE to TI-RADS in differentiating malignant nodules from benign ones. Methods. A total of 1,498 patients (885 women and 613 men; mean age of 43.5 ± 12.4 years) with 1,525 confirmed thyroid nodules (D = maximum diameter, D ≤ 2.5 cm) confirmed by fine-needle aspiration (FNA) and/or surgery were included. The nodules were divided into four groups based on their sizes (D ≤ 0.5 cm, 0.5 < D ≤ 1.0 cm, 1.0 < D ≤ 2.0 cm, and 2.0 < D ≤ 2.5 cm). We assigned an ES of RTE and malignant risk stratification of the TI-RADS category to each nodule. The correlation between the ES of RTE and the malignant risk stratification of TI-RADS category was analyzed by the Spearman’s rank correlation. The diagnostic performances of RTE, TI-RADS, and their combination were compared by the receiver operator characteristic (ROC) analysis. Results. The ES of RTE and the malignant risk stratification of TI-RADS showed a strong correlation in the size intervals of 0.5 < D ≤ 1.0 cm, 1.0 < D ≤ 2.0 cm, and 2.0 < D ≤ 2.5 cm (r = 0.768, 0.711, and 0.743, respectively). The diagnostic performance of their combination for each size interval was always better than RTE or TI-RADS alone (for all, P<0.001). Conclusions. Overall, The ES of RTE was strongly correlated with the malignant risk stratification of TI-RADS. The diagnostic performance of the combination of RTE and TI-RADS outperformed RTE or TI-RADS alone. Therefore, RTE may be an adjunctive tool to the current TI-RADS system for differentiating malignant from benign thyroid nodules.

scholarly journals Thyroid Imaging Reporting and Data System (TI-RADS): the impact of Quantitative Strain Elastography for better stratification of cancer risks.

2015 ◽  
Vol 17 (3) ◽  
pp. 327 ◽  
Author(s):  
Dana Stoian ◽  
Bogdan Timar ◽  
Mihnea Derban ◽  
Stelian Pantea ◽  
Florian Varcus ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Risk Stratification ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Data System ◽  
Strain Elastography ◽  
Thyroid Imaging ◽  
Risk Stratification Model ◽  
Area Under Roc Curve ◽  
The Impact

Aims: Due to the elevated prevalence of the solid thyroid nodules in a general population, an appropriate selection of cases referred to surgery is of paramount importance. The main aim of our study was to evaluate the performance of the Thyroid Imaging Reporting and Data System (TI-RADS) as a differential diagnosis tool for thyroid nodules. Material and methods: We evaluated 174 nodules using TI-RADS risk stratification model, using conventional ultrasound and real time elastography parameters and linear multifrequency probe (Hitachi Preirus Machine, Hitachi Inc., Japan). All the nodules were classified using the TI-RADS system according to echogenicity, margins, shapes, calcification, lymph nodes, and increased strain ra- tion. The results were compared with the pathology exam, which was considered the golden standard diagnosis. Results: The prevalence of malignant nodules was 16.7% (29 cases). The differential diagnosis performance regarding the malignant tumor for TI-RADS is appropriate for clinical use, obtaining an area under ROC curve of 0.95761 [0.8424-0.989] 95% confidence interval. Combining TI-RADS 2, 3 and 4A as probably benign and TI-RADS 4B and 5 as probably malignant, the sensitiv- ity, specificity, positive predictive value, and negative predictive value were 97.93%, 86.20%, 97.26% and 89.28% respec- tively. The overall accuracy of the method was 95.97%.According to the American Association of Clinical Endocrinologists Guidelines, 169 cases required FNAB examination; by applying the TI-RADS scoring system, the necessity for FNAB would decrease to 74 cases. Conclusion: Quantitative strain elastography, as the 6th parameter of TI-RADS system, adds diagnostic power to the risk stratification model.

scholarly journals Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5581
Author(s):  
Nina Malika Popova ◽  
Maija Radzina ◽  
Peteris Prieditis ◽  
Mara Liepa ◽  
Madara Rauda ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Diagnostic Accuracy ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Data Systems ◽  
Malignancy Risk ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Sensitivity Specificity ◽  
The Bethesda System

Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity.

scholarly journals A retrospective study correlating Ultrasound based Thyroid Imaging Reporting and Data System(TIRADS) with Bethesda System for Thyroid cytopathology in thyroid nodule risk stratification

2021 ◽  
Vol 03 ◽  
Author(s):  
Rajeev Chaturvedi ◽  
Ashok Kumar ◽  
Balaji Balasubramanian ◽  
Sreekala Sreehari
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Data System ◽  
Receiver Operating Curve ◽  
Thyroid Imaging ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
Undetermined Significance

Objective: To evaluate the efficacy of the ultrasound based Thyroid Imaging Reporting and Data System (TIRADS)in estimating risk of malignancy in thyroid nodules by correlating it with Bethesda system of thyroid cytopathology. Methods: A retrospective single center study was conducted in a specialty hospital in UAE from November 2017 to November 2019 on 259 thyroid nodules which underwent ultrasound and fine needle aspiration cytology (FNAC). Thyroid nodules were evaluated using American College of Radiology (ACR) TIRADS and categorized as benign (TR1), not suspicious (TR2), mildly suspicious (TR3), moderately suspicious (TR4), or highly suspicious (TR5) for malignancy. The risk of malignancy associated with each TIRADS category was evaluated by comparing it with the Bethesda system classification of cytopathology. Results: Ultrasound and FNAC data of 259 nodules was reviewed. Out of these 33 (12.7%) nodules were excluded because FNAC revealed atypia of undetermined significance or follicular lesion of undetermined significance. The estimated risk of malignancy in TR 3 was 13.6%, in TR4 was 27% and TR5 was 63.6%. There was statistically significant correlation between –TIRADS and Bethesda system using Chi-square test (p<0.001). The receiver operating curve (ROC) analysis revealed specificity of 81.3 % [95% CI, 74.9-86.6%], NPV of 91 % [95% CI, 87.1–93.8%] and accuracy of 77.9% [95% CI, 71.9–83.1%] in differentiating benign from malignant nodules. Conclusion: The ultrasound based ACR- TIRADS scoring correlates well with the Bethesda cytopathology in thyroid nodule risk stratification. Thus, it can be used as a simple and effective tool to decide further management and avoid unnecessary FNAC and surgeries in thyroid nodules.

scholarly journals Reliability of a computer-aided system in the evaluation of indeterminate ultrasound images of thyroid nodules

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
J L Reverter ◽  
L Ferrer-Estopiñan ◽  
F Vázquez ◽  
S Ballesta ◽  
S Batule ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Risk Stratification ◽  
Real World ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Ultrasound Images ◽  
Cad System ◽  
The Us ◽  
Computer Aided

Introduction Computer-aided diagnostic (CAD) programs for malignancy risk stratification from ultrasound (US) imaging of thyroid nodules are being validated both experimentally and in real-world practice. However, they have not been tested for reliability in analyzing difficult or unclear images. Methods US images with indeterminate characteristics were evaluated by five observers with different experience in US examination and by a commercial CAD program. The nodules, on which the observers widely agreed, were considered concordant and, if there was little agreement, not concordant or difficult to assess. The diagnostic performance of the readers and the CAD program was calculated and compared in both groups of nodule images. Results In the group of concordant thyroid nodules (n = 37), the clinicians and the CAD system obtained similar levels of accuracy (77.0% vs 74.2%, respectively; P = 0.7) and no differences were found in sensitivity (SEN) (95.0% vs 87.5%, P = 0.2), specificity (SPE) (45.5 vs 49.4, respectively; P = 0.7), positive predictive value (PPV) (75.2% vs 77.7%, respectively; P = 0.8), nor negative predictive value (NPV) (85.6 vs 77.7, respectively; P = 0.3). When analyzing the non-concordant nodules (n = 43), the CAD system presented a decrease in accuracy of 4.2%, which was significantly lower than that observed by the experts (19.9%, P = 0.02). Conclusions Clinical observers are similar to the CAD system in the US assessment of the risk of thyroid nodules. However, the AI system for thyroid nodules AmCAD-UT® showed more reliability in the analysis of unclear or misleading images.

scholarly journals Risk of Malignancy in Thyroid Nodules Using the American College of Radiology Thyroid Imaging Reporting and Data System in the NIFTP Era

2018 ◽  
Vol 50 (10) ◽  
pp. 735-737 ◽  
Author(s):  
Pedro Rosario ◽  
Alexandre da Silva ◽  
Maurício Nunes ◽  
Michelle Borges
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Neoplasm ◽  
Malignant Tumours ◽  
Thyroid Imaging ◽  
Risk Of Malignancy ◽  
Nuclear Features

AbstractRecently, the American College of Radiology (ACR) proposed a Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodules based on ultrasonographic features. It is important to validate this classification in different centres. The present study evaluated the risk of malignancy in solid nodules>1 cm using ACR TI-RADS. The risk of malignancy was defined including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and after its exclusion from malignant tumours. For the present study, the original images were revised, and each nodule was assigned to one of the TI-RADS levels proposed for solid nodules: TR3, TR4, or TR5. This risk of malignancy was significantly different for the three levels: 1.7%, 11.2%, and 60.6% for TR3, TR4, and TR5, respectively, when NIFTP was included, and 0.6%, 7.9%, and 60.2% for TR3, TR4, and TR5, respectively, when NIFTP was excluded from malignant tumours. The nodules corresponding to NIFTP were classified according to ACR as TR3 in 28.5% of cases, TR4 in 67.8%, and TR5 in only 3.5%. The nodules corresponding to cancer were classified according to ACR as TR3 in only 2.3% of cases, TR4 in 27%, and TR5 in 70.5%. In conclusion, this study shows the validity of the ACR TI-RADS for solid thyroid nodules, even after the exclusion of NIFTP from malignant tumours.

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