COMPARISON OF DIAGNOSTIC PERFORMANCE BETWEEN THE AMERICAN COLLEGE OF RADIOLOGY THYROID IMAGING REPORTING AND DATA SYSTEM AND AMERICAN THYROID ASSOCIATION GUIDELINES: A SYSTEMATIC REVIEW

2020 ◽  
Vol 26 (5) ◽  
pp. 552-563 ◽  
Author(s):  
Qing Zhang ◽  
Jian Ma ◽  
Weijing Sun ◽  
Lanlan Zhang
Keyword(s):  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Data System ◽  
American Thyroid Association ◽  
Summary Receiver Operating Characteristic ◽  
Thyroid Imaging ◽  
The Cost ◽  
Receiver Operating

Objective: We aimed to compare the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) with the American Thyroid Association (ATA) guidelines in risk stratification of thyroid nodules. Methods: We performed a computerized search of Medline, EMBASE, Web of Science, Cochrane Library, and Google Scholar to identify eligible articles published before July 31, 2019. We included studies providing head-to-head comparison between ACR TI-RADS and ATA guidelines, with fine-needle aspiration biopsy cytology results or pathology results as the reference standard. Quality assessment of included studies was conducted using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. Summary estimates of sensitivity and specificity were calculated by bivariate modeling and hierarchical summary receiver operating characteristic modeling. We also performed multiple subgroup analyses and meta-regression. Results: Twelve original articles with 13,000 patients were included, involving a total of 14,867 thyroid nodules. The pooled sensitivity of ACR TI-RADS and ATA guidelines was 0.84 (95% confidence interval [CI], 0.76–0.89) and 0.89 (95% CI, 0.80–0.95), with specificity of 0.67 (95% CI, 0.56–0.76) and 0.46 (95% CI, 0.29–0.63), respectively. There were no significant differences between the two classification criteria in terms of both sensitivity ( P = .26) and specificity ( P = .05). For five studies providing direct comparison of ACR TI-RADS, ATA guidelines, and Korean TI-RADS, our analyses showed that the Korean TI-RADS yielded the highest sensitivity (0.89; 95% CI, 0.82–0.94), but at the cost of a significant decline in specificity (0.23; 95% CI, 0.17–0.30). Conclusion: Both classification criteria demonstrated favorable sensitivity and moderate specificity in the stratification of thyroid nodules. However, use of ACR TI-RADS could avoid a large number of biopsies at the cost of only a slight decrease in sensitivity. Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; HSROC = hierarchical summary receiver operating characteristic; SROC = summary receiver operating characteristic; TI-RADS = Thyroid Imaging Reporting and Data System; US = ultrasonography

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

GUIDELINE IMPLEMENTATION ON FINE-NEEDLE ASPIRATION FOR THYROID NODULES: FOCUSING ON MICRONODULES

2020 ◽  
Vol 26 (9) ◽  
pp. 1017-1025
Author(s):  
Si Eun Lee ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
Vivian Youngjean Park ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Guideline Implementation ◽  
Needle Aspiration ◽  
Data System ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Thyroid Imaging

Objective: We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines. Methods: Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation. Results: The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) ( P<.001). Conclusion: Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules. Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; FNA = fine-needle aspiration; K-TIRADS = Korean Thyroid Imaging Reporting and Data System; LN = lymph node; TIRADS = Thyroid Imaging Reporting and Data System; US = ultrasound

scholarly journals The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI-RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Fei Chen ◽  
Yungang Sun ◽  
Guanqi Chen ◽  
Yuqian Luo ◽  
Guifang Xue ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Data System ◽  
Receiver Operating Curve ◽  
American Thyroid Association ◽  
Diagnostic Efficacy ◽  
Thyroid Imaging ◽  
Significant Difference ◽  
Stratification System ◽  
Receiver Operating

Background. This study is aimed at evaluating the diagnostic efficacy of ultrasound-based risk stratification for thyroid nodules in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) risk stratification systems. Methods. 286 patients with thyroid cancer were included in the tumor group, with 259 nontumor cases included in the nontumor group. The ACR TI-RADS and ATA risk stratification systems assessed all thyroid nodules for malignant risks. The diagnostic effect of ACR and ATA risk stratification system for thyroid nodules was evaluated by receiver operating characteristic (ROC) analysis using postoperative pathological diagnosis as the gold standard. Results. The distributions and mean scores of ACR and ATA rating risk stratification were significantly different between the tumor and nontumor groups. The lesion diameter > 1  cm subgroup had higher malignant ultrasound feature rates detected and ACR and ATA scores. A significant difference was not found in the ACR and ATA scores between patients with or without Hashimoto’s disease. The area under the receiver operating curve (AUC) for the ACR TI-RADS and the ATA systems was 0.891 and 0.896, respectively. The ACR had better specificity (0.90) while the ATA system had higher sensitivity (0.92), with both scenarios having almost the same overall diagnostic accuracy (0.84). Conclusion. Both the ACR TI-RADS and the ATA risk stratification systems provide a clinically feasible thyroid malignant risk classification, with high thyroid nodule malignant risk diagnostic efficacy.

scholarly journals Perbandingan Kriteria ACR-1997 dan SLICC-2012 dalam Diagnosis Lupus Eritematosus Sistemik pada Anak

Sari Pediatri ◽  
2021 ◽  
Vol 22 (6) ◽  
pp. 386
Author(s):  
Dwi Lestari Pramesti ◽  
Dina Muktiarti
Keyword(s):  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Systemic Lupus ◽  
Summary Receiver Operating Characteristic ◽  
American College Of Rheumatology ◽  
Review Manager ◽  
Receiver Operating

Latar belakang. Lupus eritematosus sistemik merupakan penyakit autoimun sistemik pada jaringan ikat yang bersifat kronik dan progresif, terutama pada anak. Hingga saat ini belum ada diagnosis baku emas, sehingga untuk menegakkan diagnosis dapat menggunakan kriteria The American College of Rheumatology (ACR) tahun 1997 atau The Systemic Lupus International Collaborating Clinics (SLICC) tahun 2012.Tujuan. Mengumpulkan bukti ilmiah perbandingan penggunaan kriteria ACR-1997 dan SLICC-2012 dalam diagnosis lupus eritematosus sistemik pada anak.Metode. Penelusuran literatur secara sistematis secara daring melalui database Pubmed dan Cochrane. Analisis dilakukan menggunakan Review Manager dan model hierarchical summary receiver operating characteristic (HSROC) pada studi meta-analsiis. Kualitas studi dinilai dengan QUADAS-2.Hasil. Satu artikel telaah sistematis dan meta-analisis dan satu artikel studi longitudinal dilakukan telaah kritis. Kualitas kedua studi dinilai baik. Studi oleh Hartman dkk menunjukkan kriteria ACR-1997 lebih dianjurkan sebagai kriteria klasifikasi LES pada anak karena lebih spesifik (94,1% vs 82%) dan menghindari terjadinya positif palsu. Studi kedua oleh Lythgoe dkk menunjukkan SLICC-2012 lebih sensitif (92,9% vs 84,1%) dan secara lebih dini mengklasifikasi pasien anak dengan LES.Kesimpulan. Kriteria SLICC-2012 memiliki sensitivitas yang lebih tinggi dalam klasifikasi LES pada anak tetapi memiliki spesifisitas yang lebih rendah dibandingkan ACR-1997. Namun, SLICC-2012 dapat mengklasifikasi LES lebih dini secara signifikan dibandingkan ACR-1997.

scholarly journals Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1,000 nodules

2016 ◽  
Vol 14 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Antonio Rahal Junior ◽  
Priscila Mina Falsarella ◽  
Rafael Dahmer Rocha ◽  
João Paulo Bacellar Costa Lima ◽  
Matheus Jorge Iani ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Data System ◽  
Fine Needle ◽  
Thyroid Imaging ◽  
Bethesda System ◽  
Bethesda Classification ◽  
The Bethesda System

ABSTRACT Objective To correlate the Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda system in reporting cytopathology in 1,000 thyroid nodules. Methods A retrospective study conducted from November 2011 to February 2014 that evaluated 1,000 thyroid nodules of 906 patients who underwent ultrasound exam and fine needle aspiration. Results A significant association was found between the TI-RADS outcome and Bethesda classification (p<0.001). Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and 92.5%, respectively). Among those classified as TI-RADS 4C and 5, most presented Bethesda 6 (68.2% and 91.3%, respectively; p<0.001). The proportion of malignancies among TI-RADS 2 was 0.8%, and TI-RADS 3 was 1.7%. Among those classified as TI-RADS 4A, proportion of malignancies was 16.0%, 43.2% in 4B, 72.7% in 4C and 91.3% among TI-RADS 5 (p<0.001), showing clear association between TI-RADS and biopsy results. Conclusion The TI-RADS is appropriate to assess thyroid nodules and avoid unnecessary fine needle aspiration, as well as to assist in making decision about when this procedure should be performed.

scholarly journals Assessment the Adherence of Radiologists to the Thyroid Imaging Reporting and Data System (TIRADS)

2021 ◽  
Author(s):  
Fariba Zarei ◽  
Mohammad Reza Sasani ◽  
Banafsheh Zeinali Rafsanjani ◽  
Mahdi Saeedi Moghadam
Keyword(s):  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Data System ◽  
Fars Province ◽  
Non Invasive ◽  
Thyroid Imaging ◽  
Invasive Method ◽  
The Mean ◽  
Echogenic Foci

Introduction: Thyroid nodules are the most common findings among adults. Usually, Fine Needle Aspiration Biopsy (FNAB) can be used to distinguish the malignant and benign lesions. Application of a non-invasive method for determining the chance of malignancy in a nodule is desirable. Thyroid Imaging Reporting and Data System (TIRADS) was introduced to decrease the unnecessary FNABs and to optimize the management of these patients. The objective of this study was to assess the adherence of radiologist’s reports to TIRADS, after 10 years from the introduction of this system to radiologists in Fars Province. Methods: In this retrospective study, sonography report of the patients, who were referred to hospital for FNAB was assessed. If the patients did not have the previous sonography reports or the report was unreadable, they would be excluded from the study. Composition, echogenicity, shape, size, and margin were assessed and scored in this study. As the reports noted to each of the above-mentioned issues, score 1 was assigned to them. SPSS version 15 was used to analyze the data and calculated the standard deviation. Results: Sonography reports of 111 out of 250 patients was evaluated. The mean score of sonography reports from 5 was 2.63±0.86. The percentage of adherence of sonography reports to the expression of the first five categories was 52.61±17.25 %. Echogenic foci were also evaluated in the patients that it existed. The radiologists were reported them in almost 81% of cases. Conclusion: Overall adherence of sonographic report to TIRADS was 57.34%. The adherence can be definitely improved by training the radiologists.

A Closer Look at “Taller-Than-Wide” Thyroid Nodules: Examining Dimension Ratio to Predict Malignancy

2021 ◽  
pp. 019459982110513
Author(s):  
Aviva S. Mattingly ◽  
Julia E. Noel ◽  
Lisa A. Orloff
Keyword(s):  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Continuous Variable ◽  
Width Ratio ◽  
Likelihood Ratios ◽  
Operating Characteristic Curve ◽  
Receiver Operating

Objective To evaluate nodule height-to-width ratio as a continuous variable predicting likelihood of thyroid malignancy. Study Design Retrospective cohort study. Setting All study information was collected from a single academic tertiary care hospital. Methods Subjects included adult patients with thyroid nodules who underwent thyroid surgery between 2010 and 2020. The following variables were collected: patient demographics, nodule dimensions via ultrasound, fine-needle aspiration biopsy results, and surgical pathology results. Statistical analysis included logistic regression modeling malignancy with variables of interest. We used a receiver operating characteristic curve to assess the discriminatory value of variables. Results Height-to-width ratio, as a continuous variable, was associated with malignancy (with each 0.1 increase in ratio; odds ratio [OR], 1.25; 95% CI, 1.14-1.37). The same relationship was true for height-to-length ratio (OR, 1.36; 95% CI, 1.24-1.56). The area under the receiver operating characteristic curve for height-to-width ratio was 63.7%. In line with current emphasis on the transverse ultrasound view, we determined 4 different height-to-width ratio intervals: <0.8, 0.8 to <1.0, 1.0 to <1.5, and ≥1.5. Likelihood ratios of malignancy for each interval were 0.6, 1.0, 2.3, and 4.9, respectively. Conclusion Our results support the association between greater height-to-width ratio and malignancy but suggest that a multilevel rather than binary variable improves prediction. The likelihood ratios at different intervals give a more nuanced view of how height-to-width ratio predicts malignancy. With continuing review of guidelines for thyroid nodule biopsy, it is important to consider these data for any point total attributed to shape.

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