1
|
Rtam N. Evaluation of the departmental inter-rater reliability when scoring thyroid nodules according to the British Thyroid Association Ultrasound-classification model: Is there significant disagreement? ULTRASOUND (LEEDS, ENGLAND) 2024; 32:76-84. [PMID: 38694831 PMCID: PMC11060119 DOI: 10.1177/1742271x231215500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 05/04/2024]
Abstract
Introduction The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2-5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author's department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Methods Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss' kappa and Gwet-AC1. The operators' accuracy was measured against the most experienced operator in the department using Cohen's kappa and percentage agreement. Results Fair agreement (Fleiss' K = 0.21) was obtained between the participants when U-scoring (U2-5). Fair-to-moderate agreement was noted between sonographers (K = 0.40). Significant variability was demonstrated between radiologists (p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists' AC1 = 0.34, sonographers' AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity (K = 0.29), composition (K = 0.33), shape (K = 0.58), margin (K = 0.45), halo (K = 0.34) and vascularity (K = 0.44). Accuracy reached fair agreement (mean Cohen's K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. Conclusion No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study.
Collapse
Affiliation(s)
- Nabil Rtam
- Ultrasound Department, Yeovil District Hospital, Somerset NHS Foundation Trust, Yeovil, UK
| |
Collapse
|
2
|
Petersen M, Schenke SA, Seifert P, Stahl AR, Görges R, Grunert M, Klemenz B, Kreissl MC, Zimny M. Correct and Incorrect Recommendations for or against Fine Needle Biopsies of Hypofunctioning Thyroid Nodules: Performance of Different Ultrasound-based Risk Stratification Systems. Nuklearmedizin 2024; 63:21-33. [PMID: 37871628 DOI: 10.1055/a-2178-6739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE To evaluate the recommendations for or against fine needle biopsy (FNB) of hypofunctioning thyroid nodules (TNs) using of five different Ultrasound (US) -based risk stratification systems (RSSs). METHODS German multicenter study with 563 TNs (≥ 10 mm) in 534 patients who underwent thyroid US and surgery. All TNs were evaluated with ACR TI-RADS, EU-TIRADS, ATA, K-TIRADS 2016 and modified K-TIRADS 2021. A correct recommendation was defined as: malignant TN with recommendation for FNB (appropriate) or benign TN without recommendation for FNB (avoided). An incorrect recommendation was defined as: malignant TN without recommendation for FNB (missed) or benign TN with recommendation for FNB (unnecessary). RESULTS ACR TI-RADS demonstrated the highest rate of correct (42.3 %) and lowest rate of incorrect recommendations (57.7 %). The other RRSs showed similar results for correct (26.5 %-35.7 %) and incorrect (64.3 %-73.5 %) recommendations. ACR TI-RADS demonstrated the lowest rate of unnecessary (73.4 %) and the highest rate of appropriate (26.6 %) FNB recommendation. For other RSSs, the rates of unnecessary and appropriate FNB were between 75.2 %-77.1 % and 22.9 %-24.8 %. The lowest rate of missed FNB (14.7 %) and the highest rate of avoided FNB (85.3 %) was found for ACR TI-RADS. For the other RSSs, the rates of missed and avoided FNB were between 17.8 %-26.9 % and 73.1 %-82.2 %. When the size cutoff was disregarded, an increase of correct recommendations and a decrease of incorrect recommendations was observed for all RSSs. CONCLUSION The RSSs vary in their ability to correctly recommend for or against FNB. An understanding of the impact of nodule size cutoffs seems necessary for the future of TIRADS.
Collapse
Affiliation(s)
- Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Germany
| | - Simone A Schenke
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, Germany
| | | | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, Germany
| | - Michael Grunert
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, Germany
- Department of Nuclear Medicine, University Hospital Ulm, Germany
| | - Burkhard Klemenz
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, Germany
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | | |
Collapse
|
3
|
Seifert P, Kühnel C, Reißmann I, Winkens T, Freesmeyer M. [Standardized acquisition and documentation of cine loops on conventional thyroid ultrasound]. Laryngorhinootologie 2024; 103:96-106. [PMID: 37956975 DOI: 10.1055/a-2192-4039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Ultrasound is the basic imaging method for the assessment of the thyroid gland. Due to the high prevalence of structural disease, the examination procedure is used very frequently in Germany, in many cases in the context of follow-up. The assessment of thyroid pathologies and their dynamics is subjected to relevant inter- and intraobserver variability. Findings that were not identified during live ultrasound cannot be assessed retrospectively. Applying an SOP for the acquisition and documentation of standardized video sequences of ultrasound images (so-called cine loops), allows for a secondary retrospective evaluation of the thyroid gland, taking into account previously acquired images analogous to other cross-sectional imaging methods such as CT or MRI. The cine loops can be acquired by non-physician personnel, stored to the local PACS and used for educational and research purposes.
Collapse
Affiliation(s)
- Philipp Seifert
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Kühnel
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Ivonne Reißmann
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Winkens
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | |
Collapse
|
4
|
Petersen M, Schenke SA, Veit F, Görges R, Seifert P, Zimny M, Croner RS, Kreissl MC, Stahl AR. Thyroid Imaging Reporting and Data Systems: Applicability of the "Taller than Wide" Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy. J Clin Med 2024; 13:514. [PMID: 38256648 PMCID: PMC10816136 DOI: 10.3390/jcm13020514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To examine the applicability of the "taller than wide" (ttw) criterium for risk assessment of thyroid nodules (TNs) in primary/secondary care units and the role of thyroid scintigraphy therein. METHODS German bicenter study performed in a setting of primary/secondary care. Patient recruitment and analysis in center A was conducted in a prospective manner. In center B, patient data were retrieved from a database that was originally generated by prospective data collection. TNs were assessed by ultrasound and thyroid scans, mostly fine needle biopsy and occasionally surgery and others. In center A, only patients who presented for the first time were included. The inclusion criterion was any TN ≥ 10 mm that had at least the following two sonographic risk features: solidity and a ttw shape. In center B, consecutive patients who had at least ttw and hypofunctioning nodules ≥ 10 mm were retrieved from the above-mentioned database. The risk of malignancy was determined according to a mixed reference standard and compared with literature data. RESULTS In center A, 223 patients with 259 TNs were included into the study. For further analysis, 200 nodules with a reference standard were available. The overall malignancy rate was 2.5% (upper limit of the 95% CI: 5.1%). After the exclusion of scintigraphically hyperfunctioning nodules, the malignancy rate increased slightly to 2.8% (upper limit of the 95% CI: 5.7%). Malignant nodules exhibited sonographic risk features additional to solidity and ttw shape more often than benign ones. In addition to the exclusion of hyperfunctioning nodules, when considering only nodules without additional US risk features, i.e., exclusively solid and ttw-nodules, the malignancy rate decreased to 0.9% (upper limit 95% CI: 3.7%). In center B, from 58 patients, 58 ttw and hypofunctioning TNs on thyroid scans with a reference standard were available. Malignant nodules from center B were always solid and hypoechoic. The overall malignancy rate of hypofunctioning and ttw nodules was 21%, with the lower limit of the 95% CI (one-sided) being 12%. CONCLUSIONS In primary/secondary care units, the lowest TIRADS categories for indicating FNB, e.g., applying one out of five sonographic risk features, may not be appropriate owing to the much lower a priori malignancy risk in TNs compared to tertiary/quaternary care units. Even the combination of two sonographic risk features, "solidity" and "ttw", may only be appropriate in a limited fashion. In contrast, the preselection of TNs according to hypofunctioning findings on thyroid scans clearly warranted FNB, even when applying only one sonographic risk criterion ("ttw"). For this reason, thyroid scans in TNs may not only be indicated to rule out hyperfunctioning nodules from FNB but also to rule in hypofunctioning ones.
Collapse
Affiliation(s)
- Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Simone A. Schenke
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Franziska Veit
- Institute of Radiology Dr. von Essen, 56068 Koblenz, Germany
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau, 63450 Hanau, Germany
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Alexander R. Stahl
- Institute for Radiology and Nuclear Medicine, Radiologie im Zentrum (RIZ), 86150 Augsburg, Germany
| |
Collapse
|
5
|
Gomes Ataide EJ, Jabaraj MS, Schenke S, Petersen M, Haghghi S, Wuestemann J, Illanes A, Friebe M, Kreissl MC. Thyroid Nodule Detection and Region Estimation in Ultrasound Images: A Comparison between Physicians and an Automated Decision Support System Approach. Diagnostics (Basel) 2023; 13:2873. [PMID: 37761240 PMCID: PMC10529523 DOI: 10.3390/diagnostics13182873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thyroid nodules are very common. In most cases, they are benign, but they can be malignant in a low percentage of cases. The accurate assessment of these nodules is critical to choosing the next diagnostic steps and potential treatment. Ultrasound (US) imaging, the primary modality for assessing these nodules, can lack objectivity due to varying expertise among physicians. This leads to observer variability, potentially affecting patient outcomes. PURPOSE This study aims to assess the potential of a Decision Support System (DSS) in reducing these variabilities for thyroid nodule detection and region estimation using US images, particularly in lesser experienced physicians. METHODS Three physicians with varying levels of experience evaluated thyroid nodules on US images, focusing on nodule detection and estimating cystic and solid regions. The outcomes were compared to those obtained from a DSS for comparison. Metrics such as classification match percentage and variance percentage were used to quantify differences. RESULTS Notable disparities exist between physician evaluations and the DSS assessments: the overall classification match percentage was just 19.2%. Individually, Physicians 1, 2, and 3 had match percentages of 57.6%, 42.3%, and 46.1% with the DSS, respectively. Variances in assessments highlight the subjectivity and observer variability based on physician experience levels. CONCLUSIONS The evident variability among physician evaluations underscores the need for supplementary decision-making tools. Given its consistency, the CAD offers potential as a reliable "second opinion" tool, minimizing human-induced variabilities in the critical diagnostic process of thyroid nodules using US images. Future integration of such systems could bolster diagnostic precision and improve patient outcomes.
Collapse
Affiliation(s)
- Elmer Jeto Gomes Ataide
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
| | | | - Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- Department of Nuclear Medicine, Klinikum Bayreuth, 95445 Bayreuth, Germany
| | - Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Sarvar Haghghi
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Jan Wuestemann
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
| | | | - Michael Friebe
- Surag Medical GmbH, 39118 Magdeburg, Germany
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Krakow, Poland
- Center for Innovation, Business Development and Entrepreneurship (CIBE), FOM University of Applied Science, 45127 Essen, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- STIMULATE Research Campus, 39106 Magdeburg, Germany
- Center for Advanced Medical Engineering (CAME), Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
| |
Collapse
|
6
|
Solymosi T, Hegedűs L, Bonnema SJ, Frasoldati A, Jambor L, Karanyi Z, Kovacs GL, Papini E, Rucz K, Russ G, Nagy EV. Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics. Eur Thyroid J 2023; 12:e220134. [PMID: 36692389 PMCID: PMC10083668 DOI: 10.1530/etj-22-0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. Methods After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet's AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. Results On a scale from 0.0 to 1.0, the Gwet's AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases. Conclusions Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.
Collapse
Affiliation(s)
- Tamas Solymosi
- Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Hegedűs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Andrea Frasoldati
- Endocrinology Unit of Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Laszlo Jambor
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Karanyi
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabor L Kovacs
- 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary
| | | | - Karoly Rucz
- 1st Department of Medicine, University of Pecs, Pecs, Hungary
| | - Gilles Russ
- Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
7
|
Staibano P, Ham J, Chen J, Zhang H, Gupta MK. Inter-Rater Reliability of Thyroid Ultrasound Risk Criteria: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:485-493. [PMID: 36039947 DOI: 10.1002/lary.30347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/05/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The most commonly employed diagnostic criteria for identifying thyroid nodules include Thyroid Imaging and Reporting Data System (TI-RADS) and American Thyroid Association (ATA) guidelines. The purpose of this systematic review and meta-analysis is to determine the inter-rater reliability of thyroid ultrasound criteria. METHODS We performed a library search of MEDLINE (Ovid), EMBASE (Ovid), and Web of Science for full-text articles published from January 2005 to June 2022. We included full-text primary research articles that used TI-RADS and/or ATA guidelines to evaluate thyroid nodules in adults. These included studies must have calculated inter-rater reliability using any validated metric. The Quality Appraisal for Reliability Studies (QAREL) was used to assess study quality. We planned for a random-effects meta-analysis, in addition to covariate and publication bias analyses. This study was performed in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines and registered prior to conduction (International prospective register of systematic reviews-PROSPERO: CRD42021275072). RESULTS Of the 951 articles identified via the database search, 35 met eligibility criteria. All studies were observational. The most commonly utilized criteria were ACR Thyroid Imaging and Reporting Data System (TI-RADS) and/or ATA criteria, while the majority of studies employed Κ statistics. For ACR TI-RADS, the pooled Κ was 0.51 (95% confidence interval [CI]: 0.42, 0.57; n = 7) while for ATA, the pooled Κ was 0.52 (95% CI: 0.37, 0.67; n = 3). Due to the small number of studies, covariate or publication bias analyses were not performed. CONCLUSION Ultrasound criteria demonstrate moderate inter-rater reliability, but these findings are impacted by poor study quality and a lack of standardization. Laryngoscope, 133:485-493, 2023.
Collapse
Affiliation(s)
- Phillip Staibano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Ham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Chen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael K Gupta
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
8
|
Wright K, Brandler TC, Fisher JC, Rothberger GD, Givi B, Prescott J, Suh I, Patel KN. The clinical significance of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) category 5 thyroid nodules: Not as risky as we think? Surgery 2023; 173:239-245. [PMID: 36511283 DOI: 10.1016/j.surg.2022.06.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the prevalence of thyroid nodules is high, few prove to be malignant. Based on sonographic features, the American College of Radiology Thyroid Imaging Reporting and Data System categorizes malignancy risk of thyroid nodules with associated management recommendations for each category level. Malignancy rates among nodules with a highly suspicious Thyroid Imaging Reporting and Data System category 5 warrant examination in the context of additional risk stratification tools, including cytopathology and molecular testing. METHODS All patients who underwent fine-needle aspiration biopsy for Thyroid Imaging Reporting and Data System category 5 nodules from January 2018 to September 2021 in a large integrated academic health system were reviewed. Using the Bethesda System for Reporting Thyroid Cytopathology, categories V and VI were set as malignant. Molecular testing (ThyroSeq version 3; Rye Brook, NY) yielding ≥50% risk of malignancy was deemed positive and correlated with surgical pathology. RESULTS A total of 496 Thyroid Imaging Reporting and Data System category 5 nodules were identified. On fine-needle aspiration cytopathology, 61 (12.3%) were malignant. The breakdown included Bethesda System for Reporting Thyroid Cytopathology I, 15 (3%); II, 362 (73%); III, 52 (10.5%); IV, 5 (1%); V, 6 (1.3%); and VI, 55 (11.1%). Of Bethesda System for Reporting Thyroid Cytopathology III/IV nodules with molecular testing (n = 53), 24.5% yielded positive results. In total, 42 (8.5%) nodules underwent surgical resection, most of which were Bethesda System for Reporting Thyroid Cytopathology VI (n = 26, 61.9%). Of excised nodules, 33 (78.6%) nodules were malignant, 6 (14.3%) benign, and 3 (7.1%) noninvasive follicular thyroid neoplasm with papillary-like nuclear features. All Thyroid Imaging Reporting and Data System category 5 nodules with malignant cytology (Bethesda System for Reporting Thyroid Cytopathology V/VI) that underwent surgery were malignant on histopathology. On average, the total Thyroid Imaging Reporting and Data System points were higher in malignant nodules compared with benign (9.3 vs 7.3; P = .015). Moreover, benign nodules more frequently received Thyroid Imaging Reporting and Data System points when the radiologist was unable to determine composition or echogenicity (33% vs 3% among malignant nodules; P = .01). CONCLUSION Thyroid Imaging Reporting and Data System category 5 designation in thyroid nodules is associated with a lower risk of malignancy than previously reported. Benign and malignant nodules with Thyroid Imaging Reporting and Data System category 5 designation have discrepancies in certain Thyroid Imaging Reporting and Data System characteristics and individual points assigned, which may offer an opportunity for quality improvement and standardization measures in ultrasound reporting practices.
Collapse
Affiliation(s)
- Kyla Wright
- New York University (NYU) Grossman School of Medicine, NYU Langone Health, NY
| | | | | | | | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, NY
| | | | - Insoo Suh
- Department of Surgery, NYU Langone Health, NY
| | | |
Collapse
|
9
|
Li G, Zhang B, Liu J, Xiong Y. The diagnostic efficacy and inappropriate biopsy rate of ACR TI-RADS and ATA guidelines for thyroid nodules in children and adolescents. Front Endocrinol (Lausanne) 2023; 14:1052945. [PMID: 37051202 PMCID: PMC10083478 DOI: 10.3389/fendo.2023.1052945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND This study is aimed at evaluating the diagnostic efficacy and unnecessary fine-needle aspiration (FNA) rate 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 Children and adolescents with pathology confirmed thyroid nodules were retrospectively included in this study. A total of 217 thyroid nodules from multicenter of Union Medical College Hospital, China Japan Friendship Hospital and Civil Aviation Hospital were included, the diagnostic efficiency and unnecessary FNA rate were calculated according to ACR and ATA guidelines. RESULTS Among all thyroid nodules, 139 nodules were malignant, and 78 nodules were benign. Choosing ATA high suspicion and ACR TI-RADS TR5 as benign and malignant cut-off points, the area under the curve and sensitivity of ATA were higher than ACR (AUC: 0.887 vs 0.840, p=0.0037; sensitivity 81.3% vs 71.0%, P <0.049;specificity 96.2% vs 97.4%, p=1.000;specificity both 85.9%); choosing high/intermediate suspicion in ATA and ACR TR4/5 as benign and malignant cut-off points, the two guidelines demonstrated similar diagnostic efficacy (AUC:0.890 vs 0.897, p=0.6038, sensitivity 92.1% vs 93.5%, P =0.817;specificity both 85.9%, p=1.000). The inappropriate FNA rate of ACR guideline was relatively lower (ATA 42.9% vs ACR 27.2%, P <0.001). If ACR TI-RADS TR5 nodules less than 1.0cm were included in the FNA indication, the unnecessary biopsy rate would be further reduced to 17.9%. CONCLUSION This study indicated that both ATA and ACR TI-RADS risk stratification systems could provide a feasible differential diagnosis of benign and malignant thyroid nodules, while the ACR risk stratification system demonstrates a lower rate of inappropriate FNA rate. In addition, it was necessary to further study the minimum FNA threshold of thyroid nodules in Children and adolescents in order to reduce the missed biopsy rate of malignant nodules.
Collapse
Affiliation(s)
- Guanghan Li
- Ultrasound Medical Department, China Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Ultrasound Medical Department, China Japan Friendship Hospital, Beijing, China
- *Correspondence: Bo Zhang,
| | - Jia Liu
- Department of Ultrasound, Civil Aviation General Hospital, Beijing, China
| | - Ying Xiong
- Department of Ultrasound, Civil Aviation General Hospital, Beijing, China
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Thyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment. RECENT FINDINGS To achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE. SUMMARY Multidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.
Collapse
Affiliation(s)
- Molly E. Roseland
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Body Imaging, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuni K. Dewaraja
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
11
|
Henry L, Bazin D, Policar C, Haymann JP, Daudon M, Frochot V, Mathonnet M. Characterization through scanning electron microscopy and μFourier transform infrared spectroscopy of microcalcifications present in fine needle aspiration smears. CR CHIM 2022. [DOI: 10.5802/crchim.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
12
|
Ball E, Uhlhorn M, Eksell P, Olsson U, Ohlsson Å, Low M. Repeatability of radiographic assessments for feline hip dysplasia suggest consensus scores in radiology are more uncertain than commonly assumed. Sci Rep 2022; 12:13916. [PMID: 35978034 PMCID: PMC9385612 DOI: 10.1038/s41598-022-18364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Variation in the diagnostic interpretation of radiographs is a well-recognised problem in human and veterinary medicine. One common solution is to create a 'consensus' score based on a majority or unanimous decision from multiple observers. While consensus approaches are generally assumed to improve diagnostic repeatability, the extent to which consensus scores are themselves repeatable has rarely been examined. Here we use repeated assessments by three radiologists of 196 hip radiographs from 98 cats within a health-screening programme to examine intra-observer, inter-observer, majority-consensus and unanimous-consensus repeatability scores for feline hip dysplasia. In line with other studies, intra-observer and inter-observer repeatability was moderate (63-71%), and related to the reference assessment and time taken to reach a decision. Consensus scores did show reduced variation between assessments compared to individuals, but consensus repeatability was far from perfect. Only 75% of majority consensus scores were in agreement between assessments, and based on Bayesian multinomial modelling we estimate that unanimous consensus scores can have repeatabilities as low as 83%. These results clearly show that consensus scores in radiology can have large uncertainties, and that future studies in both human and veterinary medicine need to include consensus-uncertainty estimates if we are to properly interpret radiological diagnoses and the extent to which consensus scores improve diagnostic accuracy.
Collapse
Affiliation(s)
- Elisabeth Ball
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Margareta Uhlhorn
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | | | - Åsa Ohlsson
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Matthew Low
- Department of Ecology, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| |
Collapse
|
13
|
Schenke SA, Kreissl MC, Grunert M, Hach A, Haghghi S, Kandror T, Peppert E, Rosenbaum-Krumme S, Ruhlmann V, Stahl A, Wanjura D, Zaplatnikov K, Zimny M, Gilman E, Herrmann K, Görges R. Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany. Nuklearmedizin 2022; 61:376-384. [PMID: 35917825 DOI: 10.1055/a-1856-4052] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, 99mTc-pertechnetate and 123Iodine. The functional status is relevant for diagnostic procedures for the differentiation of benign and malignant TNs. The aim of this study was to examine the current frequencies of hyper-, hypo- and isofunctioning TNs in Germany and to estimate the risk of malignancy with regard to functional status. METHODS In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs. RESULTS Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%. CONCLUSION In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.
Collapse
Affiliation(s)
- Simone Agnes Schenke
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | | | - Michael Grunert
- Klinik für Nuklearmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Anja Hach
- Institut für Radiologie und Nuklearmedizin Bremerhaven, Bremerhaven, Germany
| | - Sarvar Haghghi
- Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | | | - Eckhard Peppert
- ANZW, Ambulant-Nuklearmedizinsches Zentrum Würzburg, Würzburg, Germany
| | | | - Verena Ruhlmann
- Gemeinschaftspraxis Nuklearmedizin Duisburg, Duisburg, Standort Moers, Germany
| | | | | | | | - Michael Zimny
- Standort Hanau, Überörtliche Berufsausübungsgemeinschaft für Nuklearmedizin Hanau, Hanau, Germany
| | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Rainer Görges
- Gemeinschaftspraxis Nuklearmedizin Duisburg, Duisburg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| |
Collapse
|
14
|
Li W, Sun Y, Xu H, Shang W, Dong A. Systematic Review and Meta-Analysis of American College of Radiology TI-RADS Inter-Reader Reliability for Risk Stratification of Thyroid Nodules. Front Oncol 2022; 12:840516. [PMID: 35646667 PMCID: PMC9136001 DOI: 10.3389/fonc.2022.840516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the inter-reader agreement of using the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) for risk stratification of thyroid nodules. Methods A literature search of Web of Science, PubMed, Cochrane Library, EMBASE, and Google Scholar was performed to identify eligible articles published from inception until October 31, 2021. We included studies reporting inter-reader agreement of different radiologists who applied ACR TI-RADS for the classification of thyroid nodules. Quality assessment of the included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and Guidelines for Reporting Reliability and Agreement Studies. The summary estimates of the inter-reader agreement were pooled with the random-effects model, and multiple subgroup analyses and meta-regression were performed to investigate various clinical settings. Results A total of 13 studies comprising 5,238 nodules were included in the current meta-analysis and systematic review. The pooled inter-reader agreement for overall ACR TI-RADS classification was moderate (κ = 0.51, 95% CI 0.42–0.59). Substantial heterogeneity was presented throughout the studies, and meta-regression analyses suggested that the malignant rate was the significant factor. Regarding the ultrasound (US) features, the best inter-reader agreement was composition (κ = 0.58, 95% CI 0.53–0.63), followed by shape (κ = 0.57, 95% CI 0.41–0.72), echogenicity (κ = 0.50, 95% CI 0.40–0.60), echogenic foci (κ = 0.44, 95% CI 0.36–0.53), and margin (κ = 0.34, 95% CI 0.24–0.44). Conclusions The ACR TI-RADS demonstrated moderate inter-reader agreement between radiologists for the overall classification. However, the US feature of margin only showed fair inter-reader reliability among different observers.
Collapse
Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Yuan Sun
- Department of Burn and Plastic Surgery, Affiliate Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Haibing Xu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Wenwen Shang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Anding Dong
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
- *Correspondence: Anding Dong,
| |
Collapse
|
15
|
Belovarac B, Zhou F, Modi L, Sun W, Shafizadeh N, Negron R, Yee-Chang M, Szeto O, Simsir A, Sheth S, Brandler TC. Evaluation of ACR TI-RADS cytologically indeterminate thyroid nodules and molecular profiles: a single-institutional experience. J Am Soc Cytopathol 2022; 11:165-172. [PMID: 35181254 DOI: 10.1016/j.jasc.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The American College of Radiology (ACR) Thyroid Imaging Reporting and Data Systems (TI-RADS) was developed to standardize thyroid ultrasound reports and predict the likelihood of malignancy. In our study, we aimed to correlate indeterminate thyroid fine needle aspiration cytology cases with preceding ultrasound (US) ACR TI-RADS scores and concurrent molecular testing results to examine how well the use of the ACR TI-RADS in our institution predicted which patients with indeterminate cytology might harbor molecular alterations. MATERIALS AND METHODS We performed a retrospective review of thyroid nodules. Patients with US reports that included TI-RADS scores, fine needle aspiration specimens with indeterminate cytology (Bethesda class III-V), and molecular testing results were included. RESULTS A total of 46 indeterminate cytology cases had had preceding US reports with TI-RADS scores and molecular testing (Bethesda class III, n = 37; Bethesda class IV, n = 6; Bethesda class V, n = 3). Most of the indeterminate cases had had a TI-RADS score of TR4 (31 of 46; 67.39%) or TR5 (9 of 46; 19.57%). RAS mutations were the most common alteration (n = 12). Of the 46 cases, 22 (47.85%) showed no alterations. Ten cases proceeded to surgery, of which seven displayed malignancies. CONCLUSIONS Molecular testing in cytologically indeterminate thyroid nodules provided valuable information for TR4 and TR5 lesions; however, the TR2 and TR3 lesions often had no molecular alterations. These findings highlight the potential value of including US imaging features when assessing the significance of indeterminate cytology findings.
Collapse
Affiliation(s)
- Brendan Belovarac
- Department of Pathology, New York University Langone Health, New York, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, New York
| | - Lopa Modi
- Department of Pathology, New York University Langone Health, New York, New York; Department of Pathology, Englewood Health, Englewood, New Jersey
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York, New York
| | - Negin Shafizadeh
- Department of Pathology, New York University Langone Health, New York, New York
| | - Raquel Negron
- Department of Pathology, New York University Langone Health, New York, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University Langone Health, New York, New York
| | - Oliver Szeto
- Department of Pathology, New York University Langone Health, New York, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York, New York
| | - Sheila Sheth
- Department of Radiology, New York University Langone Health, New York, New York
| | - Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York, New York.
| |
Collapse
|
16
|
Introducing a Pole Concept for Nodule Growth in the Thyroid Gland: Taller-than-Wide Shape, Frequency, Location and Risk of Malignancy of Thyroid Nodules in an Area with Iodine Deficiency. J Clin Med 2022; 11:jcm11092549. [PMID: 35566675 PMCID: PMC9104008 DOI: 10.3390/jcm11092549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: (i) To examine the criterion taller-than-wide (TTW) for the sonographic assessment of thyroid nodules in areas of iodine deficiency in terms of frequency, anatomical distribution within the thyroid gland and risk of malignancy. (ii) To develop a model for nodule growth in the thyroid gland. Methods: German multicenter study consisting of two parts. In the prospective part, thyroid nodules were sonographically measured in all three dimensions, location within the thyroid gland and contact to a protrusion-like formation (horn) in the dorsal position of thyroid gland was noted. In addition, further sonographic features such as the composition, echogenity, margins and calcifications were investigated. All nodules from the prospective part were assessed for malignancy as part of clinical routine at the decision of the treating physician adhering to institutionally based algorithms. In the retrospective part, only nodules with fine needle aspiration and/or histology were included. The risk of malignancy in TTW nodules was determined by correlating them with cyotological and histological results. Results: Prospective part: out of 441 consecutively evaluated thyroid nodules, 6 were found to be malignant (1.4%, 95% CI 0.6–2.7%). Among the 74 TTW nodules (17%), 1 was malignant (1%, 95% CI 0–4%). TTW nodules were more often located in the dorsal half of the thyroid than non-TTW nodules (factor 2.3, p = 0.01, 95% CI 2.1–2.5) and more often located in close proximity to a horn than non-TTW nodules (factor 3.0, p = 0.01, 95% CI 2.4–3.8). Retrospective part: out of 1315 histologically and/or cytologically confirmed thyroid nodules, 163 TTW nodules were retrieved and retrospectively analyzed. A TTW nodule was 1.7 times more often benign when it was dorsal (95% CI 1.1–2.5) and 2.5 times more often benign when it was associated with a horn (95% CI 1.2–5.3). The overall probability of malignancy for TTW nodules was 38% (95% CI 30–46%) in this highly preselected patient group. Conclusion: TTW nodules are common in iodine deficient areas. They are often located in the dorsal half of the thyroid gland and are frequently associated with a dorsal protrusion-like formation (horn) of the thyroid. Obviously, the shape of benign nodules follows distinct anatomical preconditions within the thyroid gland. The frequency of TTW nodules and their predominant benignity can be explained by a pole concept of goiter growth. The difference between the low malignancy risk of TTW nodules found on a prospective basis and the high risk found retrospectively may be the result of a positive preselection in the latter.
Collapse
|
17
|
Du Y, Bara M, Katlariwala P, Croutze R, Resch K, Porter J, Sam M, Wilson MP, Low G. Effect of training on resident inter-reader agreement with American College of Radiology Thyroid Imaging Reporting and Data System. World J Radiol 2022; 14:19-29. [PMID: 35126875 PMCID: PMC8788165 DOI: 10.4329/wjr.v14.i1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) was introduced to standardize the ultrasound characterization of thyroid nodules. Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations. Despite its widespread adoption, there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience. We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TI-RADS, a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.
AIM To evaluate the inter-reader agreement of radiology residents in using ACR TI-RADS before and after training.
METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed. Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each. Three PGY-4 radiology residents (trainees) were selected as blinded readers for this study. Each trainee had between 4 to 5 mo of designated ultrasound training. No trainee had received specialized TI-RADS training prior to this study. Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart. Fleiss kappa was used to measure the pooled inter-reader agreement. The relative diagnostic performance of readers, pre- and post-training, when compared against the reference standard.
RESULTS There were 33 females and 7 males with a mean age of 56.6 ± 13.6 years. The mean nodule size was 19 ± 14 mm (range from 5 to 63 mm). A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables: 1. “Shape” (k of 0.09 [slight] pre-training vs 0.67 [substantial] post-training, P < 0.001), 2. “Echogenic foci” (k of 0.28 [fair] pre-training vs 0.45 [moderate] post-training, P = 0.004), 3. ‘TI-RADS level’ (k of 0.14 [slight] pre-training vs 0.36 [fair] post-training, P < 0.001) and 4. ‘Recommendations’ (k of 0.36 [fair] pre-training vs 0.50 [moderate] post-training, P = 0.02). No significant differences between the pre- and post-training assessments were found for the variables 'composition', 'echogenicity' and 'margins'. There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high (76.6%-96.8%) for all TI-RADS level.
CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed. Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
Collapse
Affiliation(s)
- Yang Du
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Meredith Bara
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Roger Croutze
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Katrin Resch
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Jonathan Porter
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
| |
Collapse
|
18
|
Chen F, Sun Y, Chen G, Luo Y, Xue G, Luo K, Ma H, Yao J, Zhu Z, Li G, Li Q. 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. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9995962. [PMID: 35075371 PMCID: PMC8783731 DOI: 10.1155/2022/9995962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Fei Chen
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Yungang Sun
- Department of Nuclear Medicine Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Guanqi Chen
- School of Data and Computer Science, Sun Yat-sen University, No. 132, Outer Ring East Road, Guangzhou Higher Education Mega Center, Guangzhou, Guangdong, China 510006
| | - Yuqian Luo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, 321 Zhong Shan Road, Nanjing 210008, China
| | - Guifang Xue
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Kongmei Luo
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Haoyuan Ma
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Jiaxin Yao
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Zhangtian Zhu
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| | - Guanbin Li
- School of Data and Computer Science, Sun Yat-sen University, No. 132, Outer Ring East Road, Guangzhou Higher Education Mega Center, Guangzhou, Guangdong, China 510006
| | - Qiang Li
- General Surgery Center Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China 510280
| |
Collapse
|
19
|
Petersen M, Schenke SA, Firla J, Croner RS, Kreissl MC. Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules-Results of a Prospective Study. Diagnostics (Basel) 2022; 12:diagnostics12010109. [PMID: 35054275 PMCID: PMC8774661 DOI: 10.3390/diagnostics12010109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/12/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose: To compare the diagnostic performance of thyroid imaging reporting and data system (TIRADS) in combination with shear wave elastography (SWE) for the assessment of thyroid nodules. Methods: A prospective study was conducted with the following inclusion criteria: preoperative B-mode ultrasound (US) including TIRADS classification (Kwak-TIRADS, EU-TIRADS), quantitative SWE and available histological results. Results: Out of 43 patients, 61 thyroid nodules were detected; 10 nodules were found to be thyroid cancer (7 PTC, 1 FTC, 2 HüCC) and 51 were benign. According to Kwak-TIRADS the majority of benign nodules (47 out of 51, 92.2%) were classified in the low-risk- and intermediate-risk class, four nodules were classified as high-risk (7.8%). When using EU-TIRADS, the benign nodules were distributed almost equally across all risk classes, 21 (41.2%) nodules were classified in the low-risk class, 16 (31.4%) in the intermediate-risk class and 14 (27.4%) in the high-risk class. In contrast, most of the malignant nodules (eight out of ten) were classified as high-risk on EU-TIRADS. One carcinoma was classified as low-risk and one as intermediate-risk nodule. For SWE, ROC analysis showed an optimal cutoff of 18.5 kPa to distinguish malignant and benign nodules (sensitivity 80.0%, specificity 49.0%, PPV 23.5% and NPV 92.6%). The addition of elastography resulted in an increase of accuracy from 65.6% to 82.0% when using Kwak-TIRADS and from 49.2% to 72.1% when using EU-TIRADS. Conclusion: Our data demonstrate that the combination of TIRADS and SWE seems to be superior for the risk stratification of thyroid nodules than each method by itself. However, verification of these results in a larger patient population is mandatory.
Collapse
Affiliation(s)
- Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany;
- Correspondence: ; Tel./Fax: +49-(0)391-67-15500
| | - Simone A. Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.A.S.); (J.F.); (M.C.K.)
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany
| | - Jonas Firla
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.A.S.); (J.F.); (M.C.K.)
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany;
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.A.S.); (J.F.); (M.C.K.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| |
Collapse
|
20
|
González Vásquez CM, Muñoz Durán JA, Isaza Zapata S, González Londoño JF, García Gómez V. Concordance of the ACR TI-RADS. RADIOLOGIA 2021; 63:469-475. [PMID: 34801179 DOI: 10.1016/j.rxeng.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS The ACR TI-RADS classification system is reproducible.
Collapse
Affiliation(s)
| | - J A Muñoz Durán
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | - S Isaza Zapata
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | | | - V García Gómez
- Radiólogo, Hospital Pablo Tobón Uribe, Antioquia, Colombia
| |
Collapse
|
21
|
Seifert P, Schenke S, Zimny M, Stahl A, Grunert M, Klemenz B, Freesmeyer M, Kreissl MC, Herrmann K, Görges R. Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial. Cancers (Basel) 2021; 13:cancers13174467. [PMID: 34503277 PMCID: PMC8431215 DOI: 10.3390/cancers13174467] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30% of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency.
Collapse
Affiliation(s)
- Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, 07749 Jena, Germany;
- Correspondence: (P.S.); (S.S.)
| | - Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, 39120 Magdeburg, Germany;
- Correspondence: (P.S.); (S.S.)
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau, 63450 Giessen, Germany;
| | - Alexander Stahl
- Institute for Radiology and Nuclear Medicine RIZ, 86150 Augsburg, Germany;
| | - Michael Grunert
- Department of Nuclear Medicine, German Armed Forces Hospital of Ulm, 89081 Ulm, Germany; (M.G.); (B.K.)
| | - Burkhard Klemenz
- Department of Nuclear Medicine, German Armed Forces Hospital of Ulm, 89081 Ulm, Germany; (M.G.); (B.K.)
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, 07749 Jena, Germany;
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, 39120 Magdeburg, Germany;
| | - Ken Herrmann
- Department of Nuclear Medicine, Essen University Hospital, 45147 Essen, Germany; (K.H.); (R.G.)
| | - Rainer Görges
- Department of Nuclear Medicine, Essen University Hospital, 45147 Essen, Germany; (K.H.); (R.G.)
- Joint Practice for Nuclear Medicine, Duisburg (Moers), 47441 Duisburg, Germany
| |
Collapse
|
22
|
Russ G, Trimboli P, Buffet C. The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls. Cancers (Basel) 2021; 13:cancers13174316. [PMID: 34503125 PMCID: PMC8430750 DOI: 10.3390/cancers13174316] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The aim of this review is to provide the reader with a comprehensive overview of thyroid imaging and reporting data systems used for thyroid nodules, so as to understand how nodules are scored with all existing systems. Both ultrasound based risk stratification systems and indications for fine-needle aspirations are described. Systems are compared by analyzing their strengths and weaknesses. Studies show satisfactory sensitivities and specificities for the diagnosis of malignancy for all systems, and none of them have shown a real significant advantage over the others in terms of raw diagnostic value. Interobserver agreement is also very similar for all systems, fairly adequate to robust. Dimensional cut-offs for fine-needle aspiration are quite similar and all RSSs seem to reduce effectively the number of unnecessary FNAs. Merging all existing systems in a common international one is desirable. Abstract Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains.
Collapse
Affiliation(s)
- Gilles Russ
- Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013 Paris, France;
- Correspondence:
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Camille Buffet
- Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013 Paris, France;
| |
Collapse
|
23
|
Håskjold OI, Foshaug HS, Iversen TB, Kjøren HC, Brun VH. Prediction of thyroid nodule histopathology by expert ultrasound evaluation. Endocr Connect 2021; 10:776-781. [PMID: 34156970 PMCID: PMC8346181 DOI: 10.1530/ec-21-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The basis of thyroid nodule diagnostics is ultrasound-guided fine needle biopsy with cytological evaluation (FNC) if ultrasound appearance is not clearly benign. The aim of this study was to investigate the predictive potential of dedicated, expert high-resolution ultrasound, to see if histopathological entities of thyroid nodules can be diagnosed without invasive FNC biopsies. DESIGN Prospective case-cohort study. METHODS 187 patients with 221 thyroid nodules were examined with ultrasound and prospectively assigned to the expected histopathological diagnosis: colloid nodule, adenomatoid colloid nodule, follicular adenoma, follicular carcinoma, follicular variant of papillary thyroid carcinoma, papillary thyroid carcinoma, or other thyroid cancer. In 101 of these, we later obtained histopathological reports for comparison. RESULTS Overall accuracy for classification into discrete histopathological categories by expert ultrasound was 71.3% and Cohen's Kappa was 0.62. The sensitivity and specificity for detecting malignancy were 97.3% and 78.1%. The diagnostic accuracy for malignancy was 85.1%. ACR-TIRADS scores for the same nodules had a sensitivity of 97.3%, specificity of 26.6%, and accuracy of 52.5%. CONCLUSION Dedicated expert high-resolution ultrasound without FNC can reliably distinguish benign vs malignant nodules, but also differentiate between several histopathological entities in thyroid nodules. There is potential for a reduction in the number of invasive FNC biopsies and diagnostic operations.
Collapse
Affiliation(s)
- Olav Inge Håskjold
- Department of Breast and Endocrine Surgery, University Hospital of North Norway, Tromsø, Norway
| | | | | | | | - Vegard Heimly Brun
- Department of Breast and Endocrine Surgery, University Hospital of North Norway, Tromsø, Norway
- UiT – The Arctic University of Norway, Institute of Clinical Medicine, Tromsø, Norway
- Correspondence should be addressed to V H Brun:
| |
Collapse
|
24
|
Schenke SA, Campenni A, Tuncel M, Piccardo A, Sager S, Bogovic Crncic T, Rozic D, Goerges R, Özcan Kara PP, Groener D, Hautzel H, Klett R, Kreissl MC, Giovanella L. A multicenter survey of current practices of 99mTc-methoxy-isobutyl-isonitrile (MIBI) imaging for the diagnosis of thyroid nodules: more standardization is essential. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Purpose
Molecular imaging with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI, MIBI) has been used in the assessment of thyroid nodules (TNs) for more than two decades. Many studies showed that MIBI imaging is a suitable tool to rule-out malignancy when negative. However, relatively low specificity and accuracy have been described, thus, limiting its acceptance in clinical practice. Additionally, different technologies, protocols, and interpretation criteria are adopted accounting for heterogeneous data reported in the literature. Therefore, the present study was undertaken to assess the clinical use and methodology of MIBI imaging in patients with nodular thyroid disease in Europe.
Methods
A questionnaire was sent to 12 European centers of Nuclear Medicine. The questionnaire encompassed ultrasound (US) and fine-needle aspiration cytology (FNAC) procedures and their evaluation as well scintigraphy imaging indications, technical procedures, and interpretation criteria of MIBI imaging.
Results
The survey showed a good agreement of different centers in approaching TNs by TSH measurement, US evaluation and 99mTc-pertechnetate thyroid scintigraphy. MIBI imaging is mainly used to assess TNs with inconclusive/indeterminate cytological findings and selection of target nodule(s) for FNAC in patients with multi-nodular goiter. Technical procedures adopted in different centers are globally comparable and the recorded differences are unlikely to impact clinical results. However, as the main result of the present study, substantial differences were found in interpretation criteria adopted in different centers.
Conclusions
Our survey supports the urgent need of standardized interpretation criteria of thyroid MIBI imaging in order to improve its diagnostic performance and make results comparable in clinical practice.
Collapse
|
25
|
Wu GG, Lv WZ, Yin R, Xu JW, Yan YJ, Chen RX, Wang JY, Zhang B, Cui XW, Dietrich CF. Deep Learning Based on ACR TI-RADS Can Improve the Differential Diagnosis of Thyroid Nodules. Front Oncol 2021; 11:575166. [PMID: 33987082 PMCID: PMC8111071 DOI: 10.3389/fonc.2021.575166] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Objective The purpose of this study was to improve the differentiation between malignant and benign thyroid nodules using deep learning (DL) in category 4 and 5 based on the Thyroid Imaging Reporting and Data System (TI-RADS, TR) from the American College of Radiology (ACR). Design and Methods From June 2, 2017 to April 23, 2019, 2082 thyroid ultrasound images from 1396 consecutive patients with confirmed pathology were retrospectively collected, of which 1289 nodules were category 4 (TR4) and 793 nodules were category 5 (TR5). Ninety percent of the B-mode ultrasound images were applied for training and validation, and the residual 10% and an independent external dataset for testing purpose by three different deep learning algorithms. Results In the independent test set, the DL algorithm of best performance got an AUC of 0.904, 0.845, 0.829 in TR4, TR5, and TR4&5, respectively. The sensitivity and specificity of the optimal model was 0.829, 0.831 on TR4, 0.846, 0.778 on TR5, 0.790, 0.779 on TR4&5, versus the radiologists of 0.686 (P=0.108), 0.766 (P=0.101), 0.677 (P=0.211), 0.750 (P=0.128), and 0.680 (P=0.023), 0.761 (P=0.530), respectively. Conclusions The study demonstrated that DL could improve the differentiation of malignant from benign thyroid nodules and had significant potential for clinical application on TR4 and TR5.
Collapse
Affiliation(s)
- Ge-Ge Wu
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, China
| | - Rui Yin
- Department of Ultrasound, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Jian-Wei Xu
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu-Jing Yan
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui-Xue Chen
- Department of Ultrasound, Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jia-Yu Wang
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhang
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, China
| | - Xin-Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Christoph F Dietrich
- Department of General Internal Medicine, Kliniken Hirslanden Beau-Site, Bern, Switzerland
| |
Collapse
|
26
|
Update on ACR TI-RADS: Successes, Challenges, and Future Directions, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021; 216:570-578. [PMID: 33112199 DOI: 10.2214/ajr.20.24608] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound-based risk stratification system (RSS) for thyroid nodules that was released in 2017. Since publication, research has shown that ACR TI-RADS has a higher specificity than other RSSs and reduces the number of unnecessary biopsies of benign nodules compared with other systems by 19.9-46.5%. The risk of missing significant cancers using ACR TI-RADS is mitigated by the follow-up recommendations for nodules that do not meet criteria for biopsy. In practice, after a nodule's ultrasound features have been enumerated, the ACR TI-RADS points-based approach leads to clear management recommendations. Practices seeking to implement ACR TI-RADS must engage their radiologists in understanding how the system addresses the problems of thyroid cancer overdiagnosis and unnecessary surgeries by reducing unnecessary biopsies. This review compares ACR TI-RADS to other RSSs and explores key clinical questions faced by practices considering its implementation. We also address the challenge of reducing interobserver variability in assigning ultrasound features. Finally, we highlight emerging imaging techniques and recognize the ongoing international effort to develop a system that harmonizes multiple RSSs, including ACR TI-RADS.
Collapse
|
27
|
Ultrasound Cine Loop Standard Operating Procedure for Benign Thyroid Diseases-Evaluation of Non-Physician Application. Diagnostics (Basel) 2021; 11:diagnostics11010067. [PMID: 33406645 PMCID: PMC7824138 DOI: 10.3390/diagnostics11010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Conventional ultrasound (US) is time-consuming, and results are subjected to high interobserver variability. In this study, the reliability of a novel thyroid US cine loop standard operating procedure (SOP) applied by non-physicians (Medical Technical Assistant, MTA) is investigated. Thirty-three consecutive patients (22 females, 11 males) were enrolled. Patients underwent conventional thyroid US performed by a nuclear medicine physician and additional MTA US cine loop according to a local SOP that includes transversal and sagittal cine loops covering the entire thyroid. The video sequences were transferred to the Picture Archiving and Communication System (PACS) for second reading purposes. MTA US data were not considered for medical reports but for blinded second reading review of the PACS images. The results of conventional physician US reports and reviewed MTA US cine loops were compared regarding size determinations of the thyroid and its nodules, as well as Thyroid Imaging Reporting and Data Systems (TIRADS) classification of all identified lesions. The results revealed very high concordance between conventional physician US and MTA US cine loop review for both size measurements and TIRADS classifications (r(s) = 0.84-0.99, p < 0.0001 each). Minor technical impairments were identified. The evaluated thyroid US cine loop SOP enables reliable second reading results and can be applied by non-physicians.
Collapse
|
28
|
Grani G, Sponziello M, Pecce V, Ramundo V, Durante C. Contemporary Thyroid Nodule Evaluation and Management. J Clin Endocrinol Metab 2020; 105:5850848. [PMID: 32491169 PMCID: PMC7365695 DOI: 10.1210/clinem/dgaa322] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. EVIDENCE ACQUISITION We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. EVIDENCE SYNTHESIS The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. CONCLUSION Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Correspondence and Reprint Requests: Cosimo Durante, MD, PhD, Dipartimento di Medicina Traslazionale e di Precisione, Università di Roma “Sapienza,” Viale del Policlinico 155, 00161, Roma, Italy. E-mail:
| |
Collapse
|
29
|
Suh YJ, Choi YJ. Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery. Endocrine 2020; 69:578-586. [PMID: 32297204 DOI: 10.1007/s12020-020-02300-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules. METHODS Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model. RESULTS Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAFV600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAFV600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029). CONCLUSION K-TIRADS 5 and BRAFV600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS.
Collapse
Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, 14068, Republic of Korea.
| | - Yeon Ju Choi
- Research Cooperation Center, Hallym University, Chuncheon, 24252, Republic of Korea
| |
Collapse
|
30
|
Trimboli P, Durante C. Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era. Endocrine 2020; 69:1-4. [PMID: 31933234 DOI: 10.1007/s12020-020-02196-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Ultrasound (US) has long played a major role in the assessment of thyroid nodules and their risk of malignancy, and its importance has been further enhanced over the past decade by the development of a number of US-based risk stratification systems (US-RSSs), referred to in some cases as TIRADS (Thyroid Imaging Reporting And Data Systems). The high-risk categories of all currently available US-RSSs display strong associations to cytological diagnostic classes of "malignant/suspicious-for-malignancy" and the low-risk classes are clearly associated to "not neoplastic/benign" cytology. The introduction of these systems has elevated the diagnostic performance of US to a level approaching that of fine-needle aspiration (FNA) cytology. The time seems ripe to exploit this new level of accuracy to reduce the number of FNAs for nodules likely to be benign (i.e., sonographically classified as low-risk with no suspicious clinical features). In the near future, US-RSS could also become the main tool for diagnosing papillary thyroid cancers. The establishment of a new "international TIRADS"-currently in progress-will be critical to guide us towards a new era.
Collapse
Affiliation(s)
- Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, 6500, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, 6900, Switzerland.
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, 00161, Italy
| |
Collapse
|
31
|
Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students. SENSORS 2020; 20:s20123409. [PMID: 32560336 PMCID: PMC7349481 DOI: 10.3390/s20123409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
In conventional thyroid diagnostics, the topographical correlation between thyroid nodules (TN) depicted on ultrasound (US) in axial or sagittal orientation and coronally displayed scintigraphy images can be challenging. Sensor-navigated I-124-PET/US fusion imaging has been introduced as a problem-solving tool for ambiguous cases. The purpose of this study was to investigate the results of multiple unexperienced medical students (MS) versus multiple nuclear medicine physicians (MD) regarding the overvalue of I-124-PET/US in comparison to conventional diagnostics (CD) for the functional assessment of TN. METHODS Out of clinical routine, cases with ambiguous findings on CD were selected for I-124-PET/US fusion imaging. Sixty-eight digital patient case files (PCF) of 34 patients (CDonly and CD+PET/US PCF) comprising 66 TN were provided to be retrospectively evaluated by 70 MD and 70 MS, respectively. A total of 2174 ratings (32.9 per TN) were carried out: 555 ratings (8.4 per TN) for CDonly and 532 ratings (8.1 per TN) for CD+PET/US by each MD and MS. RESULTS Functional assessment revealed 8.5%/11.7% (n.s.) (16.4%/25.8% (p = 0.0002)), 41.8%/28.5% (p < 0.0001) (23.9%/17.9% (p = 0.0193)), 36.0%/30.5% (n.s.) (57.3%/53.9% (n.s.)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) hyperfunctioning, indifferent, hypofunctioning, and not rateable TNs for CDonly (CD+PET/US) and MD/MS, respectively. The respective rating confidence was indicated as absolute certain, quite certain, equivocal, uncertain, and not rateable in 11.7/3.4% (p < 0.0001) (44.9%/38.9% (p = 0.0541), 51.9%/26.7% (p < 0.0001) (46.2%/41.5% (n.s.)), 21.6%/29.0% (p = 0.0051) (6.2%/14.8% (p < 0.0001)), 1.1%/11.5% (p < 0.0001) (0.2%/2.3% (p = 0.0032)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) by MD/MS, respectively. There was a significant difference in the diversity of the observers' functional assessment of TN (MD 0.84 vs. MS 1.02, p = 0.0006) and the respective confidence in functional assessment (MD 0.93 vs. MS 1.16, p < 0.0001) between MD and MS on CDonly, whereas CD+PET/US revealed weaker differences for both groups (MD 0.48 vs. MS 0.47, p = 0.57; and MD 0.66 vs. MS 0.83, p = 0.0437). With the additional application of I-124-PET/US, the rating diversity of both MD and MS markedly tends towards more consistency (p < 0.0001 in each case). CONCLUSION The additional application of sensor-navigated I-124-PET/US fusion imaging significantly influenced the functional assessment of TN positively, especially for unexperienced observers.
Collapse
|
32
|
González Vásquez CM, Muñoz Durán JA, Isaza Zapata S, González Londoño JF, García Gómez V. Concordance of the ACR TI-RADS. RADIOLOGIA 2020; 63:S0033-8338(20)30071-0. [PMID: 32522374 DOI: 10.1016/j.rx.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS The ACR TI-RADS classification system is reproducible.
Collapse
Affiliation(s)
| | - J A Muñoz Durán
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | - S Isaza Zapata
- Residente de Radiología, Universidad CES, Antioquia, Colombia
| | | | - V García Gómez
- Radiólogo, Hospital Pablo Tobón Uribe, Antioquia, Colombia
| |
Collapse
|
33
|
Sutton W, Canner JK, Rooper LM, Prescott JD, Zeiger MA, Mathur A. Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule? Am J Surg 2020; 221:111-116. [PMID: 32532458 DOI: 10.1016/j.amjsurg.2020.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4 cm with benign cytology. METHODS We performed a single-institution retrospective review of patients who underwent surgery from 07/2008-08/2019 for a cytologically benign thyroid nodule ≥4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression. RESULTS Of 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients ≥55. Patient age ≥55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1-0.7,p = 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7-1.4,p = 0.980, and OR:9.6,95%CI:0.9-107.8,p = 0.066, respectively). CONCLUSIONS Patients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4 cm.
Collapse
Affiliation(s)
- Whitney Sutton
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joseph K Canner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Lisa M Rooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jason D Prescott
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Aarti Mathur
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| |
Collapse
|
34
|
Thejeel B, Rahimi B, Seidler M, Al-Agha R, Fung C. Evaluation of Thyroid Ultrasound Report Quality and Assessing Effect of Adherence to Risk Stratification Criteria on Referral for Thyroid Nodule Biopsy. Can Assoc Radiol J 2020; 72:234-241. [PMID: 32090615 DOI: 10.1177/0846537119900634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to evaluate the quality of diagnostic thyroid ultrasound reports and determine the impact of consistent adherence to 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) on reducing unnecessary referrals for thyroid nodule biopsy. MATERIALS AND METHODS Reports from 291 referrals for thyroid nodule biopsy were included for retrospective report evaluation (males: 42; mean age: 56) according to 2015 ATA and ACR TI-RADS lexicon. Cytology results were collected for each patient. Two radiologists blinded to cytology results independently, retrospectively reviewed imaging of the referrals, and rescored them according to 2015 ATA and 2017 ACR TI-RADS risk stratification systems. Statistical analysis was completed using chi-square analysis and calculation of κ statistic for interobserver variability. RESULTS No report completely addressed all features associated with malignancy. Over half of the reports did not include descriptors on echogenicity, shape, margin, or echogenic foci. In all, 9.3% of biopsies showed malignant histology. Rescoring of referrals demonstrated decrease in biopsy referrals by 55% as per 2017 ACR TI-RADS and 14% as per 2015 ATA (P < .0001). There was no impact on detection of malignancy with adherence to ATA or ACR criteria and less interobserver variability with application of 2017 ACR TI-RADS compared to 2015 ATA. CONCLUSION Thyroid ultrasound report quality was found variable with respect to nodule description. Reports recommended biopsy based on nodule size with no detailed description of other imaging features. Adherence to risk stratification system would have resulted in significant reduction in the number of unnecessary biopsy referrals.
Collapse
Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Diagnostic Imaging, 2J2.00 WC Mackenzie Health Sciences Centre, 3158University of Alberta, Alberta, Canada
| | - Behruz Rahimi
- 142066LMC Diabetes and Endocrinology, Alberta, Canada
| | - Michael Seidler
- Department of Radiology and Diagnostic Imaging, 2J2.00 WC Mackenzie Health Sciences Centre, 3158University of Alberta, Alberta, Canada
| | - Rany Al-Agha
- Division of Endocrinology and Metabolism, 3158University of Alberta, Alberta, Canada
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, 2J2.00 WC Mackenzie Health Sciences Centre, 3158University of Alberta, Alberta, Canada
| |
Collapse
|
35
|
Schenke S, Klett R, Seifert P, Kreissl MC, Görges R, Zimny M. 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). J Clin Med 2020; 9:E236. [PMID: 31963140 PMCID: PMC7019412 DOI: 10.3390/jcm9010236] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| | - Rigobert Klett
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Am Klinikum 1 A4U1, 07740 Jena Lobeda-Ost, Germany;
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
| | - Rainer Görges
- Department of Nuclear Medicine, Essen University Hospital, Hufelandstraße 55, 45122 Essen, Germany;
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| |
Collapse
|