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

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

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Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

Hormone Research in Paediatrics ◽

10.1159/000509118 ◽

2020 ◽

Vol 93 (4) ◽

pp. 239-244

Author(s):

Shruthi Arora ◽

Jane Khoury ◽

Andrew T. Trout ◽

Janet Chuang

Keyword(s):

Predictive Value ◽

Lower Risk ◽

Thyroid Nodules ◽

Pediatric Population ◽

Retrospective Chart Review ◽

Needle Aspiration ◽

Risk Category ◽

American Thyroid Association ◽

Risk Of Malignancy

Introduction: The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. Objectives: To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. Methods: A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. Results: A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7–22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9–99.6) and the positive predictive value was 83.3% (95% CI 57.2–98.2). Conclusion: Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.

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

Endocrine Practice ◽

10.4158/ep-2019-0237 ◽

2020 ◽

Vol 26 (5) ◽

pp. 552-563 ◽

Cited By ~ 1

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

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USING THE ATA AND ACR TI-RADS SONOGRAPHIC CLASSIFICATIONS AS ADJUNCTIVE PREDICTORS OF MALIGNANCY FOR INDETERMINATE THYROID NODULES

Endocrine Practice ◽

10.4158/ep-2018-0559 ◽

2019 ◽

Vol 25 (9) ◽

pp. 908-917 ◽

Cited By ~ 13

Author(s):

Sara Ahmadi ◽

Rebecca Herbst ◽

Taofik Oyekunle ◽

Xiaoyin ‘Sara’ Jiang ◽

Kyle Strickland ◽

...

Keyword(s):

Ultrasound Imaging ◽

Thyroid Nodules ◽

Clinical Decision Making ◽

Data System ◽

Follicular Neoplasm ◽

American Thyroid Association ◽

Thyroid Imaging ◽

Risk Of Malignancy ◽

Indeterminate Cytology ◽

Undetermined Significance

Objective: Thyroid nodules with indeterminate cytology pose management challenges in clinical practice. The aim of this study was to determine the efficacy of ultrasound features in navigating clinical decision making in thyroid nodules with indeterminate cytology. Methods: We retrospectively reviewed ultrasound imaging from 186 adult patients with thyroid nodules and indeterminate cytology who underwent thyroidectomy at a quaternary hospital from 2010–2017. All nodules were classified based on the American Thyroid Association (ATA) and 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Nodules were included if good quality pre-operative ultrasound imaging and surgical pathology were available. Results: A total of 202 thyroid nodules were included. The median age was 57 years; 82.8% were female. Risk of malignancy (ROM) in resected nodules with Bethesda 3 and 4 cytology was 19.4% and 30.3%, respectively. ATA high-suspicious and TI-RADS 5 nodules had high ROM, 100% in both systems for Bethesda 3 nodules; 66.7% and 50.0%, respectively, for Bethesda 4 nodules. For ATA very-low suspicious/TI-RADS 1 and 2, ROM was 0%. ROM in ATA low-suspicious/TI-RADS 3 nodules with Bethesda 3 cytology was lower (15.2% and 16.0%, respectively) than Bethesda 4 cytology (33.8% and 34.3%, respectively). ATA intermediate-suspicious/TI-RADS 4 nodules with Bethesda 4 cytology had a lower ROM (11.1% and 18.2%, respectively) than Bethesda 3 cytology (28.6 % and 31.6%, respectively). Conclusion: Using either the ATA or the TI-RADS system to risk-stratify nodules with indeterminate cytology may help clinicians plan better for additional diagnostic testing and treatment. Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; AUS = atypia of undetermined significance; FLUS = follicular lesion of undetermined significance; FN = follicular neoplasm; PPV = positive predictive value; ROM = risk of malignancy; SFN = suspicious for follicular neoplasm; TI-RADS = Thyroid Imaging Reporting and Data System

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Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

International Surgery Journal ◽

10.18203/2349-2902.isj20213121 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2286

Author(s):

Elsayed Ahmed Mostafa ◽

Radwa Mohamed Atia ◽

Muhammad Salah Ragab Abdel-Aal

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Diagnostic Value ◽

Needle Aspiration ◽

Data System ◽

Fine Needle ◽

Thyroid Imaging ◽

Thyroid Fine Needle Aspiration ◽

Risk Of Malignancy ◽

Sensitivity Specificity

Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.

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

Endocrine Practice ◽

10.4158/ep-2020-0163 ◽

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

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Diagnostic value of 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) combined with fine needle aspiration biopsy in thyroid nodules

Journal of X-Ray Science and Technology ◽

10.3233/xst-210949 ◽

2021 ◽

pp. 1-10

Author(s):

Chao Zhang ◽

Yu-Qin Huang ◽

Zhi-Long Liu

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Diagnostic Value ◽

Needle Aspiration ◽

Data System ◽

Fine Needle ◽

Thyroid Imaging ◽

Accuracy Increase ◽

Sensitivity Specificity

OBJECTIVE: To evaluate diagnostic value of Thyroid Imaging Reporting and Data System published by American College of Radiology (ACR TI-RADS) in 2017, ultrasound-guided fine-needle aspiration (US-FNA), and the combination of both methods in differentiation between benign and malignant thyroid nodules. METHODS: The data of US-FNA and ACR TI-RADS are collected from 159 patients underwent thyroid surgery in our hospital, which include a total of 178 thyroid nodules. A Bethesda System for Reporting Thyroid Cytopathology category of ≥IV and an ACR TI-RADS category ≥4 are regarded as diagnosis standards for malignancy in US-FNA and ACR TI-RADS, respectively. The pathological results after surgery are considered as the gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ACR TI-RADS, US-FNA and the combination of both methods for the differential diagnosis of thyroid nodules are calculated, respectively. RESULTS: The sensitivity, specificity and accuracy of ACR TI-RADS are 85.4%, 37.5%and 72.5%, respectively. The sensitivity, specificity and accuracy of US-FNA are 70.0%, 100%and 78.1%, respectively. After combining these two methods, the sensitivity, specificity and accuracy increase to 99.23%, 37.50%and 82.58%, respectively. The sensitivity of ACR TI-RADS is higher than that of US-FAN, and the sensitivity of combining these two methods is also higher than that of using ACR TI-RADS and US-FNA alone. CONCLUSION: The established ACR TI-RADS can help in selecting the target during nodule puncture, while the combination of ACR TI-RADS and US-FAN can further improve diagnostic ability for detecting malignant thyroid nodules.

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

Hormone and Metabolic Research ◽

10.1055/a-0743-7326 ◽

2018 ◽

Vol 50 (10) ◽

pp. 735-737 ◽

Cited By ~ 7

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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ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

BMC Endocrine Disorders ◽

10.1186/s12902-019-0429-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 11

Author(s):

Thayse Lozovoy Madsen Barbosa ◽

Cleo Otaviano Mesa Junior ◽

Hans Graf ◽

Teresa Cavalvanti ◽

Marcus Adriano Trippia ◽

...

Keyword(s):

Thyroid Nodules ◽

Clinical Decision Making ◽

Clinical Decision ◽

Needle Aspiration ◽

Molecular Testing ◽

American Thyroid Association ◽

Institutional Review ◽

The Us ◽

Risk Of Malignancy ◽

Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

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

Einstein (São Paulo) ◽

10.1590/s1679-45082016ao3640 ◽

2016 ◽

Vol 14 (2) ◽

pp. 119-123 ◽

Cited By ~ 6

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.

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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)

Journal of Clinical Medicine ◽

10.3390/jcm9010236 ◽

2020 ◽

Vol 9 (1) ◽

pp. 236 ◽

Cited By ~ 3

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.

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