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Pang EH, Carter AW, Prisman E, Kreisman SH. Cost-Effectiveness of the ACR TIRADS Compared to the ATA 2015 Risk Stratification Systems in the Evaluation of Incidental Thyroid Nodules. Acad Radiol 2024:S1076-6332(24)00210-1. [PMID: 38679528 DOI: 10.1016/j.acra.2024.04.004] [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: 12/11/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
RATIONALE AND OBJECTIVES Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules. METHODS A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained. RESULTS For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time. CONCLUSION The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules.
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Affiliation(s)
- Emily Ht Pang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Alexander W Carter
- Department of Health Policy, London School of Economics, London, England, UK
| | - Eitan Prisman
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stuart H Kreisman
- Division of Endocrinology, Department of Internal Medicine, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Yucel S, Balci IG, Tomak L. Diagnostic Performance of Thyroid Nodule Risk Stratification Systems: Comparison of ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA Guidelines. Ultrasound Q 2023; 39:206-211. [PMID: 37918114 DOI: 10.1097/ruq.0000000000000653] [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: 11/04/2023]
Abstract
ABSTRACT The purpose of this study was to compare the diagnostic performance of 4 different ultrasound-based risk scoring systems for thyroid nodules (TNs). This study consecutively included 256 patients (mean age: 43.98 ± 12.94 years, min-max: 18-89 years; 225 females, 31 males) with 266 TNs. Each nodule was evaluated and classified according to the American Thyroid Association (ATA), American College of Radiology (ACR), European Thyroid Association, and Korean Thyroid Imaging Reporting and Data System (ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively) before performing ultrasound-guided fine-needle aspiration biopsy. Pathological results were reported according to the Bethesda system. Outcomes of the 4 classification systems were compared with respect to Bethesda results. Twenty-eight (10.5%) nodules had malignant cytology results. Diagnostic performances of the scoring systems were comparable with similar area under the curve values according to the reference standards of category 5 of each scoring system. The sensitivity and specificity values of these guidelines were as follows: ACR-TIRADS, 60.7% and 95.4%; EU-TIRADS, 71.4% and 93.3%; ATA-2015, 71.4% and 93.3%; and K-TIRADS, 67.9% and 93.3%. The biopsy rate of malignant nodules was 57.1% for K-TIRADS and ATA, whereas this value was 46.4% for ACR and EU-TIRADS. ACR-TIRADS had the lowest unnecessary biopsy rate (141 of 238 benign nodules, 46%). The diagnostic performance of 4 risk stratification systems appears to be comparable, as shown by similar sensitivity, specificity, and area under the curve values. However, the ACR-TIRADS had slightly higher accuracy and necessitated fewer unnecessary biopsies for benign nodules.
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Affiliation(s)
- Serap Yucel
- Radiology Section, Basaksehir Cam ve Sakura State Hospital, Istanbul
| | - Isa Gokturk Balci
- Department of Radiology, Baskent University School of Medicine, Adana
| | - Leman Tomak
- Department of Biostatistics and Medical Informatics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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de Andrade MN, Costa JR, Sousa LM, Moreira LFGG, Oliveira RF, Álvares MCB, Maia FCP. American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology: which one is better at predicting malignancy risk? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221694. [PMID: 37729220 PMCID: PMC10511278 DOI: 10.1590/1806-9282.20221694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/23/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to compare the capacity of American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology in predicting malignancy risk of thyroid nodules and to verify which one is better at avoiding unnecessary fine needle aspiration. METHODS This was a cross-sectional study with 565 thyroid nodules, followed at a tertiary care hospital, in an iodine-replete area. Those were classified as American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology systems and stratified according to the Bethesda classification of fine needle aspiration. The values of sensibility, specificity, positive predictive value, and negative predictive value accuracy were calculated. Also, the percentage of unnecessary biopsies was presented. RESULTS The mean age of the individuals was 58.2±13.5 [26-90] years for benign nodules and 41.7±15.6 [23-66] years for malignant nodules (p=0.002). Regarding gender, 92.6% (n=150) of the individuals with benign nodules and 85.7% (n=06) with malignant nodules were females (p=0.601). For American Thyroid Association, 90.9% of sensibility, 51.4% of specificity, 52.6% of accuracy, 10.2% of positive predictive value, and 98.9% of negative predictive value were found. For Thyroid Imaging Reporting and Data System developed by the American College of Radiology, 90.9% of sensibility, 49.7% of specificity, 52.1% of accuracy, 9.9% of positive predictive value, and 98.9% of negative predictive value were found. .Notably, 12.3% of unnecessary fine needle aspiration were found in American Thyroid Association and 44.4% were found in Thyroid Imaging Reporting and Data System developed by the American College of Radiology. CONCLUSION Both Thyroid Imaging Reporting and Data System developed by the American College of Radiology and American Thyroid Association are able to predict the malignancy risk of thyroid nodules. Thyroid Imaging Reporting and Data System developed by the American College of Radiology was better at avoiding unnecessary fine needle aspiration.
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Affiliation(s)
| | | | | | | | | | | | - Flávia Coimbra Pontes Maia
- Santa Casa de Belo Horizonte – Belo Horizonte (MG), Brazil
- Faculdade de Ciências Médicas de Minas Gerais – Belo Horizonte (MG), Brazil
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Torshizian A, Hashemi F, Khoshhal N, Ghodsi A, Rastegar H, Mousavi Z, Dadgar Moghadam M, Mohebbi M. Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review. Diagnostics (Basel) 2023; 13:2972. [PMID: 37761339 PMCID: PMC10527732 DOI: 10.3390/diagnostics13182972] [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: 06/29/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
AIM This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy. METHODS The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). RESULTS Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77). CONCLUSIONS Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.
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Affiliation(s)
- Ashkan Torshizian
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Fatemeh Hashemi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Nastaran Khoshhal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Houra Rastegar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Zohreh Mousavi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Maliheh Dadgar Moghadam
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Masoud Mohebbi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq., Mashhad 13944-91388, Iran
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Ren T, Jiang M, Wu J, Zhang F, Zhang C. Clinical value of grayscale ultrasound combined with real-time shear wave elastography nomogram in risk prediction of thyroid cancer. BMC Med Imaging 2023; 23:123. [PMID: 37700270 PMCID: PMC10496161 DOI: 10.1186/s12880-023-01099-y] [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: 08/01/2022] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES This study constructed a nomogram based on grayscale ultrasound features and real-time shear wave elastography (SWE) parameters to predict thyroid cancer. METHODS Clinical data of 217 thyroid nodules of 201 patients who underwent grayscale ultrasound, real-time SWE, and thyroid function laboratory examination in Ma'anshan People's Hospital from January 2019 to December 2020 were retrospectively analyzed. The subjects were divided into a benign nodule group (106 nodules) and a malignant nodule group (111 nodules). The differences in grayscale ultrasound features, quantitative parameters of real-time SWE, and laboratory results of thyroid function between benign and malignant thyroid nodules were analyzed. We used a chi-square test for categorical variables and a t-test for continuous variables. Then, the independent risk factors for thyroid cancer were analyzed using multivariate logistic regression. Based on the independent risk factors, a nomogram for predicting thyroid cancer risk was constructed using the RMS package of the R software. RESULTS Multivariate logistic regression showed that the grayscale ultrasound features of thyroid nodules were the shape, margin, echogenicity, and echogenic foci of the nodules,the maximum Young's modulus (SWE-max) of thyroid nodules, and the ratio of thyroid nodule and peripheral gland (SWE-ratio) measured by real-time SWE were independent risk factors for thyroid cancer (all p < 0.05), and the other variables had no statistical difference (p > 0.05). Based on the shape (OR = 5.160, 95% CI: 2.252-11.825), the margin (OR = 9.647, 95% CI: 2.048-45.443), the echogenicity (OR = 6.512, 95% CI: 1.729-24.524), the echogenic foci (OR = 2.049, 95% CI: 1.118-3.756), and the maximum Young's modulus (SWE-max) (OR = 1.296, 95% CI: 1.140-1.473), the SWE-ratio (OR = 2.001, 95% CI: 1.403-2.854) of the thyroid nodule to peripheral gland was used to establish the related nomogram prediction model. The bootstrap self-sampling method was used to verify the model. The consistency index (C-index) was 0.979, ROC curve was used to analyze the nomogram scores of all patients, and the AUC of nomogram prediction of thyroid cancer was 0.976, indicating that the nomogram model had high accuracy in the risk prediction of thyroid cancer. CONCLUSIONS The nomogram model of grayscale ultrasound features combined with SWE parameters can accurately predict thyroid cancer.
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Affiliation(s)
- Tiantian Ren
- Department of Medical Ultrasound, Maanshan People’s Hospital, Hubei Road, Anhui Maanshan, 243032 China
| | - Mingfei Jiang
- School of Public Health, Southeast University, Hunan Road, Nanjing, Jiangsu 210000 China
| | - Jiawei Wu
- Department of Medical Ultrasound, Maanshan People’s Hospital, Hubei Road, Anhui Maanshan, 243032 China
| | - Fan Zhang
- Department of Medical Ultrasound, Maanshan People’s Hospital, Hubei Road, Anhui Maanshan, 243032 China
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Meishan Road, AnHui Hefei, 230000 China
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Wilkinson T, Cawood T, Lim A, Roche D, Jiang J, Thomson B, Marais M, Hunt P. Correlation of ACR TI-RADS and Patient Outcomes in a Real-World Cohort Presenting for Thyroid Ultrasonography. J Endocr Soc 2023; 7:bvad119. [PMID: 37795193 PMCID: PMC10546907 DOI: 10.1210/jendso/bvad119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 10/06/2023] Open
Abstract
Context The American College of Radiology Thyroid Image Reporting and Data System (ACR TI-RADS) was developed to predict malignancy risk in thyroid nodules using ultrasound features. TI-RADS was derived from a database of patients already selected for fine-needle aspiration (FNA), raising uncertainty about applicability to unselected patients. Objective We aimed to assess the effect of ACR TI-RADS reporting in unselected patients presenting for thyroid ultrasound in a real-world setting. Methods Records for all patients presenting for thyroid ultrasonography in Canterbury, New Zealand, were reviewed across two 18-month periods, prior to and after implementation of TI-RADS reporting. Patient outcomes were compared between the 2 periods. Malignancy rates were calculated for nodules 10 mm or larger with a definitive FNA or histology result. Results A total of 1210 nodules were identified in 582 patients prior to implementation of TI-RADS; 1253 nodules were identified in 625 patients after implementation of TI-RADS. TI-RADS category was associated with malignancy rate (0% in TR1 and TR2, 3% in TR3, 5% in TR4, 12% in TR5; P = .02); however, 63% of nodules were graded TR3 or TR4, for which malignancy rate did not meaningfully differ from baseline risk. After implementation of TI-RADS there was a small reduction in the proportion of patients proceeding to FNA (49% vs 60%; P < .01) or surgery (14% vs 18%; P < .05), with no difference in cancer diagnoses (3% vs 4%, not significant). Conclusion TI-RADS category is associated with malignancy rate and may alter clinical decision-making in a minority of patients; however, it is nondiscriminatory in the majority of nodules. In this study of unselected patients, nodules classified as TR5 and thus considered "highly suspicious" for cancer had only a modest risk of malignancy.
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Affiliation(s)
- Tom Wilkinson
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Tom Cawood
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Anthony Lim
- Department of Radiology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - David Roche
- Canterbury Southern Community Laboratories, Christchurch 8051, New Zealand
| | - Jasmine Jiang
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Ben Thomson
- Department of Otolaryngology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Michelle Marais
- Department of Radiology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Penny Hunt
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
- University of Otago (Christchurch), Christchurch 8011, New Zealand
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Chatti HA, Oueslati I, Azaiez A, Marrakchi J, Boukriba S, Mizouni H, Haouet S, Besbes G, Yazidi M, Chihaoui M. Diagnostic performance of the EU TI-RADS and ACR TI-RADS scoring systems in predicting thyroid malignancy. Endocrinol Diabetes Metab 2023:e434. [PMID: 37327183 DOI: 10.1002/edm2.434] [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: 11/06/2022] [Revised: 05/20/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Several ultrasound scoring systems have been developed to stratify the risk of malignancy of thyroid nodules, including ACR (American College of Radiology) and EU (European) TI-RADS. This study aimed to assess the diagnostic performance of these two classifications using histology as a reference standard. METHODS It was a single-centre, retrospective study including 156 patients who underwent thyroidectomy. Ultrasound data of 198 nodules (99 malignant nodules and 99 benign nodules) were analysed. Both classifications were applied for all nodules. RESULTS Ultrasound criteria associated with malignancy were solid composition (OR=7.81; p < 10-3 ), hypoechoic character (OR=16.42; p < 10-3 ), irregular contours (OR=7.47; p < 10-3 ), taller-than-wide shape (OR=3.58; p = 0.02), microcalcifications (OR=3.02; p = .006) and the presence of cervical adenopathy (OR=3.89; p = .006). The prevalence of malignancy was 15.5%, 69% and 76.9% for EU TI-RADS categories 3, 4 and 5, respectively. It was 33.3%, 57% and 91.1% for ACR TI-RADS categories 3, 4 and 5, respectively. For category 5, EU TI-RADS and ACR TI-RADS had sensitivities of 60% and 41%, specificities of 82% and 96%, respectively. For categories 4 and 5 combined, the diagnostic performance of these two classification systems became comparable with a sensitivity of 89% and 86% for EU-TIRADS and ACR-TIRADS, respectively. The area under the ROC curve was 0.81 for the EU TI-RADS classification and 0.82 for the ACR TI-RADS classification. CONCLUSIONS EU TI-RADS and ACR TI-RADS scoring systems seem to be comparable in predicting malignancy in thyroid nodules.
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Affiliation(s)
- Hiba-Allah Chatti
- Department of Endocrinology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of Endocrinology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Aymen Azaiez
- Department of Oto-Rhino-laryngology, La Rabta university Hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Jihen Marrakchi
- Department of Oto-Rhino-laryngology, La Rabta university Hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Seif Boukriba
- Department of Radiology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Habiba Mizouni
- Department of Radiology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Slim Haouet
- Department of Pathology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ghazi Besbes
- Department of Oto-Rhino-laryngology, La Rabta university Hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Meriem Yazidi
- Department of Endocrinology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Department of Endocrinology, La Rabta university hospital, Faculty of medicine, University of Tunis-El Manar, Tunis, Tunisia
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Eidt LB, Nunes de Oliveira C, Lagos YBBD, Solera GLM, Izquierdo R, Meyer ELDS, Mattevi VS, Golbert L. A prospective comparison of ACR-TIRADS and EU-TIRADS in thyroid nodule assessment for FNA-US. Clin Endocrinol (Oxf) 2023; 98:415-425. [PMID: 35864563 DOI: 10.1111/cen.14799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Prospective data on the accuracy of ultrasound (US) classification systems in thyroid nodules are still scarce. The aim of this study is to compare the accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and European (EU)-TIRADS classification systems. DESIGN AND PATIENTS Consecutive patients with one or more thyroid nodule(s) who underwent fine-needle aspiration (FNA) under ultrasonographic guidance (FNA-US) were prospectively evaluated. MEASUREMENTS Clinical evaluation and US data were collected. The reference standard used for this study was FNA-US cytology and histopathological diagnosis. RESULTS A total of 186 thyroid nodules in 166 patients were evaluated, resulting in 168 nodules from 149 patients with conclusive benign or malignant results. Sensitivity, specificity, negative predictive value (NPV) and false negative (FN) were 100.0%, 28.7%, 100.0% and 0.0%, respectively, for ACR-TIRADS; and 90.0%, 19.1%, 96.8% and 9.1% (n = 1), respectively, for EU-TIRADS. The number of unnecessary FNA-US indicated by ACR-TIRADS was lower than EU-TIRADS (71.3% vs. 80.9%, p = .017), and the number of possibly avoided FNA-US was higher (26.7% vs. 17.8%). Using the same threshold of ACR-TIRADS to indicate FNA-US in EU-TIRADS 3 nodules (2.5 cm), there was an improvement in specificity (30.6%) and avoided FNA-US (28.6%). The best performance of both systems was demonstrated when FNA-US would be indicated only in highly suspicious nodules and/or in the presence of lymphadenopathy, with 85.7% and 89.3% of possibly avoided FNA-US for ACR-TIRADS and EU-TIRADS, respectively, without increasing FN. CONCLUSION Both systems presented high sensitivity, but low specificity in selecting nodules for FNA-US. The use of nodular size for FNA-US selection is questioned.
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Affiliation(s)
- Laura Berton Eidt
- Endocrine Division, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cáren Nunes de Oliveira
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Yago Borges Biz De Lagos
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rogério Izquierdo
- Radiology Division, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Erika Laurini de Souza Meyer
- Endocrine Division, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Internal Medicine Department, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Suñé Mattevi
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lenara Golbert
- Endocrine Division, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Internal Medicine Department, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
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KUŞCU B, EROĞLU M. The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. FAMILY PRACTICE AND PALLIATIVE CARE 2023. [DOI: 10.22391/fppc.1173267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Thyroid fine-needle aspiration biopsy (TFNAB), which is basically planned according to the ultrasonographic features is of clinical importance; since it helps early diagnosis of malignancy, facilitates the selection of patients who will undergo thyroid surgery and prevents unnecessary surgical procedures. In our study, we aimed to evaluate the adequacy of TFNAB as well as the retrospective investigation of the link between the estimated malignancy risk and the descriptive features, radiologic findings and biopsy cytology of patients who underwent ultrasonography guided TFNAB.Methods: In this study, the ultrasonographic characteristics of 659 thyroid nodules belonging to 523 patients who underwent TFNAB between 2018 and 2021 were evaluated. The correlation between the risk of malignancy and demographic data, thyroid hormone levels, and ultrasonographic characteristics of nodules was examined. The diagnostic accuracy performances of European thyroid imaging reporting and data system (EU-TIRADS) classification prepared by the European Thyroid Association (ETA), the risk classification systems recommended by the American Thyroid Association (ATA) and the Society of Endocrinology and Metabolism of Turkey (TEMD) were compared with The Bethesda System for Reporting Thyroid Cytopathology (Bethesda). The adequacy of biopsy was also evaluated. The data which is obtained from the study was statistically analyzed by means of SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) program.Results: In this study, the biopsies of 41 (6.2%) among 659 thyroid nodules appeared to be malignant. A statistically significant correlation was detected between malignancy and hypoechogenicity (p=0.011), microcalcification (p=0.005), irregular margins (p=0.028), and accompanying pathological lymph node (p=0.002). Compared to the surgical pathology results, the accuracy that was closest to that of Bethesda System (AUC: 0.778) (Area Under Curve) was found in EU-TIRADS (AUC:0.715). In the biopsies performed in our own endocrinology clinic (43.7% of the total biopsies), the ratio of non-diagnostic results was found to be 8.3%, whereas it was 29.1% in the biopsies performed in other clinics (56.3% of the total biopsies).Conclusion: It should always be kept in mind that, in the cytologic evaluation, the ultrasonographic nodule pattern recommended by the guidelines is very important in the management of patients, because cytology may show false negative and false positive results as well as unclear or non-diagnostic pathological findings. However, clinicians should also understand that classification systems may have strengths and weaknesses. Our study also emphasizes the importance of how experienced a clinic performing biopsy is as well as the role of cytopathologist in obtaining diagnostic results in biopsy.Keywords: Thyroid nodule, neoplasia, ultrasonography, biopsy fine-needle
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Kim JS, Kim BG, Stybayeva G, Hwang SH. Diagnostic Performance of Various Ultrasound Risk Stratification Systems for Benign and Malignant Thyroid Nodules: A Meta-Analysis. Cancers (Basel) 2023; 15:cancers15020424. [PMID: 36672373 PMCID: PMC9857194 DOI: 10.3390/cancers15020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To evaluate the diagnostic performance of ultrasound risk-stratification systems for the discrimination of benign and malignant thyroid nodules and to determine the optimal cutoff values of individual risk-stratification systems. METHODS PubMed, Embase, SCOPUS, Web of Science, and Cochrane library databases were searched up to August 2022. Sensitivity and specificity data were collected along with the characteristics of each study related to ultrasound risk stratification systems. RESULTS Sixty-seven studies involving 76,512 thyroid nodules were included in this research. The sensitivity, specificity, diagnostic odds ratios, and area under the curves by K-TIRADS (4), ACR-TIRADS (TR5), ATA (high suspicion), EU-TIRADS (5), and Kwak-TIRADS (4b) for malignancy risk stratification of thyroid nodules were 92.5%, 63.5%, 69.8%, 70.6%, and 95.8%, respectively; 62.8%, 89.6%, 87.2%, 83.9%, and 63.8%, respectively; 20.7111, 16.8442, 15.7398, 12.2986, and 38.0578, respectively; and 0.792, 0.882, 0.859, 0.843, and 0.929, respectively. CONCLUSION All ultrasound-based risk-stratification systems had good diagnostic performance. Although this study determined the best cutoff values in individual risk-stratification systems based on statistical assessment, clinicians could adjust or alter cutoff values based on the clinical purpose of the ultrasound and the reciprocal changes in sensitivity and specificity.
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Affiliation(s)
- Ji-Sun Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Byung Guk Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-32-340-7044
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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.
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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
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Kang YJ, Stybayeya G, Lee JE, Hwang SH. Diagnostic Performance of ACR and Kwak TI-RADS for Benign and Malignant Thyroid Nodules: An Update Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14235961. [PMID: 36497443 PMCID: PMC9740871 DOI: 10.3390/cancers14235961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: To determine the optimal cut-off values of two risk stratification systems to discriminate malignant thyroid nodules and to compare the diagnostic performance; (2) Methods: True and false positive and negative data were collected, and methodological quality was assessed for forty-six studies involving 39,085 patients; (3) Results: The highest area under the receiver operating characteristic (ROC) curve (AUC) of ACR and Kwak TI-RADS were 0.875 and 0.884. Based on the optimal sensitivity and specificity, the highest accuracy values of ROC curves or diagnostic odds ratios (DOR) were taken as the cut-off values for TR4 (moderate suspicious) and 4B. The sensitivity, specificity, DOR, and AUC by ACR (TR4) and Kwak TI-RADS (4B) for malignancy risk stratification of thyroid nodules were 94.3% and 96.4%; 52.2% and 53.7%; 17.5185 and 31.8051; 0.786 and 0.884, respectively. There were no significant differences in diagnostic accuracy in any of the direction comparisons of the two systems; (4) Conclusions: ACR and Kwak TI-RADS had good diagnostic performances (AUCs > 85%). Although we determined the best cut-off values in individual risk stratification systems based on statistical assessment, clinicians can adjust the optimal cut-off value according to the clinical purpose of the ultrasonography because raising or lowering cut-points leads to reciprocal changes in sensitivity and specificity.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Gulnaz Stybayeya
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Ju Eun Lee
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea
- Correspondence: ; Tel.: +82-32-340-7044
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Diagnostic Value of AngioPLUS Microvascular Imaging in Thyroid Nodule Diagnosis Using Quantitative and Qualitative Vascularity Grading. Biomedicines 2022; 10:biomedicines10071554. [PMID: 35884858 PMCID: PMC9313421 DOI: 10.3390/biomedicines10071554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
This study investigated the diagnostic value of the Angio Planewave Ultrasensitive (AngioPLUS) Doppler ultrasound in improving the efficacy of grey scale ultrasound in thyroid nodule diagnosis. The EU TIRADS was used for the grey scale ultrasound assessment of 94 thyroid nodules. conventional Doppler and AngioPLUS Doppler ultrasound images were evaluated using qualitative vascularity grading, where predominant central vascularity indicated malignancy-suspicion, and quantitative regional vascularity assessment, where predominant peripheral vascularity using a ratio vascularity index (RVI) of > 1 indicated benign disease. Diagnostic performance outcomes of sole and combination approaches were calculated based on final pathologic results. Using sole EU TIRADS and AngioPLUS + power Doppler imaging (APDI) based on qualitative vascularity and RVI, the results were a sensitivity of 83.3% vs. 83.3 vs. 66.7% and a specificity of 50% vs. 81.3% vs. 73.4, respectively. EU TIRADS combined with APDI significantly improved the specificity using both qualitative vascularity and RVI assessment approaches (84.4% and 81%, respectively, p < 0.05); and slightly reduced the sensitivity (76.7% and 58.1%). For cytologically-equivocal thyroid nodules, the combination approach using qualitative vascularity assessment outperformed the EU TIRADS (sensitivity: both were 88.9%; specificity: 77.4% vs. 38.7%, p < 0.05; and AUROC: 0.83 vs. 0.62, p < 0.05). APDI combined with EU TIRADS is diagnostically efficient in stratifying thyroid nodules, particularly cytologically-equivocal nodules.
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Low G, Bara M, Du Y, Katlariwala P, Croutze R, Resch K, Porter J, Sam M, Wilson M. Tips for improving consistency of thyroid nodule interpretation with ACR TI-RADS. J Ultrason 2022; 22:e51-e56. [PMID: 35449702 PMCID: PMC9009349 DOI: 10.15557/jou.2022.0009] [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: 10/07/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
Thyroid nodules are very common in the general population. Most are benign and even those that are malignant are typically slow-growing and do not require treatment. Overdiagnosis and overtreatment of thyroid nodules has resulted in significant healthcare costs. ACR TI-RADS was developed to address these concerns, and reduce the number of unnecessary biopsies and follow-up intervals. ACR TI-RADS offers a point-based risk stratification system centered on five sonographic features: consistency, echogenicity, shape, margins and echogenic foci. While the system has noticeable benefits and comparable accuracy with other available risk stratification systems (ATA, EU-TIRADS and K-TIRADS), there are inherent challenges relating to suboptimal inter-reader agreement. In this article, we include 10 educational tips that may be helpful to the ultrasound practitioner for improving the consistency of nodule interpretation with ACR TI-RADS.
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Affiliation(s)
- Gavin Low
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Meredith Bara
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Yang Du
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | | | - Roger Croutze
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Katrin Resch
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Jonathan Porter
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Medica Sam
- Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Mitchell Wilson
- Radiology and Diagnostic Imaging, University of Alberta, Canada
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Thyroid Cancer Detection in a Routine Clinical Setting: Performance of ACR TI-RADS, FNAC, and Molecular Testing in Prospective Cohort Study. Biomedicines 2022; 10:biomedicines10050954. [PMID: 35625691 PMCID: PMC9139136 DOI: 10.3390/biomedicines10050954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of our study was to address the potential for improvements in thyroid cancer detection in routine clinical settings using a clinical examination, the American College of Radiology Thyroid Imaging Reporting and Database System (ACR TI-RADS), and fine-needle aspiration cytology (FNAC) concurrently with molecular diagnostics. A prospective cohort study was performed on 178 patients. DNA from FNA samples was used for next-generation sequencing to identify mutations in the genes BRAF, HRAS, KRAS, NRAS, and TERT. RNA was used for real-time PCR to detect fusion genes. The strongest relevant positive predictors for malignancy were the presence of genetic mutations (p < 0.01), followed by FNAC (p < 0.01) and ACR TI-RADS (p < 0.01). Overall, FNAC, ACR TI-RADS, and genetic testing reached a sensitivity of up to 96.1% and a specificity of 88.3%, with a diagnostic odds ratio (DOR) of 183.6. Sensitivity, specificity, and DOR decreased to 75.0%, 88.9%, and 24.0, respectively, for indeterminate (Bethesda III, IV) FNAC results. FNA molecular testing has substantial potential for thyroid malignancy detection and could lead to improvements in our approaches to patients. However, clinical examination, ACR TI-RADS, and FNAC remained relevant factors.
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Liu X, Xie L, Ye X, Cui Y, He N, Hu L. Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules. Front Oncol 2022; 12:823411. [PMID: 35251988 PMCID: PMC8889496 DOI: 10.3389/fonc.2022.823411] [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: 11/27/2021] [Accepted: 01/26/2022] [Indexed: 12/09/2022] Open
Abstract
Background Conventional ultrasound diagnosis of thyroid nodules (TNs) had a high false-positive rate, resulting in many unnecessary fine-needle aspirations (FNAs). Objective This study aimed to establish a simple algorithm to reduce unnecessary FNA on TIRADS 4 TNs using different quantitative parameters of ultrasonic elasticity and chi-square automatic interactive detector (CHAID) method. Methods From January 2020 to May 2021, 432 TNs were included in the study, which were confirmed by FNA or surgical pathology. Each TN was examined using conventional ultrasound, sound touch elastography, and Shell measurement function. The quantitative parameters E and Eshell were recorded, and the Eshell/E values were calculated for each TN. The diagnostic performance of the quantitative parameters was evaluated using the receiver operating characteristic curves. The CHAID was used to classify and analyze the quantitative parameters, and the prediction model was established. Results A total of 226 TNs were malignant and 206 were benign. Eshell and Eshell/E ratio were included in the classification algorithm, which showed a depth of two ramifications (Eshell/E ≤ 0.988 or 0.988–1.043 or >1.043; if Eshell/E ≤ 0.988, then Eshell ≤ 64.0 or 64.0–74.0 or >74.0; if Eshell/E = 0.988–1.043, then Eshell ≤ 66.0 or > 66.0; if Eshell/E >1.043, then Eshell ≤ 69.0 or >69.0). The unnecessary FNAs could have been avoided in 57.3% of the cases using this algorithm. Conclusion The prediction model using quantitative parameters had high diagnostic performance; it could quickly distinguish benign lesions and avoid subjective influence to some extent.
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Affiliation(s)
- Xiao Liu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Xie
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianjun Ye
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yayun Cui
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Nianan He
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Hu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Strieder DL, Cristo AP, Zanella AB, Faccin CS, Farenzena M, Graudenz MS, Dora JM, Maia AL, Scheffel RS. Using an ultrasonography risk stratification system to enhance the thyroid fine needle aspiration performance. Eur J Radiol 2022; 150:110244. [PMID: 35299112 DOI: 10.1016/j.ejrad.2022.110244] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 01/25/2023]
Abstract
PURPOUSE The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a risk stratification system for thyroid nodules based on their ultrasonography (US) characteristics. Here, we aimed to assess TI-RADS on fine needle aspiration biopsy (FNAB) recommendations and performance in thyroid nodules. METHODS We performed a retrospective study in a single center. All patients with thyroid nodules who underwent FNAB between 2012 and 2019 were included. TI-RADS data were extracted from medical records. Malignancy rates were defined based on cytological exams. RESULTS A total of 1,044 nodules (938 patients) were evaluated. TI-RADS classification was as follows: 13 TI-RADS 1, 524 TI-RADS 2, 273 TI-RADS 3, 148 TI-RADS 4, and 85 TI-RADS 5. TI-RADS classification showed a sensitivity of 75% (95 %CI: 63-84.7), a negative predictive value of 97.6% (95 %CI: 96.5-98.5), and accuracy of 73.1% (95 %CI: 70.3-75.8). According to TI-RADS FNAB criteria, only 314 (30%) nodules would have undergone FNAB. Of them, 157 (50%) were classified as benign (Bethesda II), 45 (14.3%) as undetermined (Bethesda III or IV), and 51 (16.2%) as malignant (Bethesda V or VI). Of the remaining 729 nodules that did not meet FNAB criteria, 17 (2.3%) had Bethesda V or VI and underwent surgery. Of them, four (23%) were <1 cm in size (microcarcinomas), and eight (47.0%) remain in follow-up according to the TI-RADS criteria. Seven malignant cases would be missed (0.9%). CONCLUSION ACR TI-RADS allows a significant decrease in the number of FNAB, increasing its diagnostic accuracy.
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Affiliation(s)
- Débora L Strieder
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana P Cristo
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André B Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlo S Faccin
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauricio Farenzena
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia S Graudenz
- Pathology Division, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Thedinger W, Raman E, Dhingra JK. Comparative Study of ACR TI-RADS and ATA 2015 for Ultrasound Risk Stratification of Thyroid Nodules. Otolaryngol Head Neck Surg 2021; 167:35-40. [PMID: 34905442 DOI: 10.1177/01945998211064607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the adoption rate of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scoring system over a 3-year period in a community setting and compare its performance with that of the American Thyroid Association 2015 (ATA 2015) ultrasound risk scoring system. STUDY DESIGN Case series with prospective data collection and retrospective chart review. SETTING Large community-based practice with multiple satellite offices and a dedicated thyroid ultrasound clinic. METHODS All patients referred to the thyroid clinic between January 2018 and December 2020 for ultrasound-guided fine-needle biopsy were assigned an ATA 2015 risk score in a prospective manner immediately prior to biopsy. ACR TI-RADS scores were recorded through retrospective chart review of the radiologist report. Performance of the 2 systems was compared with cytology as the gold standard. RESULTS A total of 949 nodules underwent biopsy, of which 236 had available data for both scoring systems. There was a 33.8% increase in adoption of the ACR TI-RADS over the 3-year study period. The ATA 2015 guidelines yielded sensitivity and specificity of 81.6% and 54.5%, respectively, as opposed to 73.7% and 27.0% for the ACR TI-RADS. CONCLUSION In our community, there has been a gradual increase in adoption of the ACR TI-RADS, although the ATA 2015 risk scoring system has performed better.
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Affiliation(s)
| | | | - Jagdish K Dhingra
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tufts University, Boston, Massachusetts, USA.,ENT Specialists, Inc, Brockton, Massachusetts, USA
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Popova NM, Radzina M, Prieditis P, Liepa M, Rauda M, Stepanovs K. Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems. Cancers (Basel) 2021; 13:cancers13215581. [PMID: 34771743 PMCID: PMC8583198 DOI: 10.3390/cancers13215581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary This study is aimed at raising the question of the use of several TIRADS systems that stratify the risk of thyroid nodule malignancy. Approximately 5–20% of thyroid nodules are malignant, but most nodules are benign, and they are scored by FNA biopsy. One of the goals is to reduce the number of unnecessary FNA and the associated with-it possible complications for the patient and financial cost. Most TIRADS systems are based on the fact that one suspicious feature of a thyroid nodule classifies it as malignant, but there is a modified Kwak et al. system that is based on the count of malignant features. Therefore, this study is intended to estimate the specificity, sensitivity, and accuracy of the systems and, in the future, think about reducing the number of FNA biopsies. The result of this study can be important for all doctors who face thyroid changes, such as radiologists, ultrasonography specialists, and endocrinologists, those who must decide about the need for an FNA. Abstract Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity.
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Affiliation(s)
- Nina Malika Popova
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Faculty of Medicine, University of Latvia, 1004 Riga, Latvia
- Correspondence: (N.M.P.); (M.R.); Tel.: +371-26069563 (N.M.P.); +371-29623585 (M.R.)
| | - Maija Radzina
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Faculty of Medicine, University of Latvia, 1004 Riga, Latvia
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
- Correspondence: (N.M.P.); (M.R.); Tel.: +371-26069563 (N.M.P.); +371-29623585 (M.R.)
| | - Peteris Prieditis
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
| | - Mara Liepa
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
| | - Madara Rauda
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
| | - Kaspars Stepanovs
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
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Cancela E Penna G, Costa CT, Pires MC, Nunes TA. Are the anatomical, clinical, and ultrasound characteristics of thyroid nodules with Bethesda III or IV cytology and ACR TI-RADS 3, 4, or 5 able to refine the indications for molecular diagnostic tests? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:625-631. [PMID: 34591407 PMCID: PMC10528568 DOI: 10.20945/2359-3997000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the association of clinical, anatomical, and ultrasound (US) characteristics of malignancies in Bethesda III or IV (III-B or IV-B) thyroid nodules. METHODS The association between malignancies and the following variables were analyzed: III-B or IV-B, age < 55 years and ≥ 55 years, sex, family history of thyroid cancer, history of irradiation, nodule size, and ACR TI-RADS classification in 62 participants who underwent thyroidectomy. RESULTS Of the 62 participants, 87.1% (54/62) were women, 74.2% were < 55 years old, 95.2% had no family history of thyroid cancer, 56.5% had nodules < 2 cm in size, 62.9% were IV-B, and 69.4% were ACR TI-RADS 4. Thirty-two patients had thyroid carcinoma, and 30 had benign histology. Among all factors associated with malignancy, only ACR TI-RADS 5 classification on US was found to be statistically significant (p = 0.014), while III-B with architectural atypia cytological classification was the only one significantly associated with benign status (p = 0.004). CONCLUSION Only a high risk of malignancy as assessed using US was able to refine the indication for molecular tests in a group of patients with indeterminate nodules. We found 85% (53/62) of III-B or IV-B thyroid nodules would benefit from available molecular diagnostic tests.
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Affiliation(s)
- Gustavo Cancela E Penna
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil,
| | - Camila Teixeira Costa
- Programa de Pós-Graduação em Ciências Aplicadas à Cirurgia e à Oftalmologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Magda Carvalho Pires
- Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Tarcizo Afonso Nunes
- Programa de Pós-Graduação em Ciências Aplicadas à Cirurgia e à Oftalmologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma-A Meta-Analysis. Cancers (Basel) 2021; 13:cancers13050938. [PMID: 33668130 PMCID: PMC7956257 DOI: 10.3390/cancers13050938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The risk of thyroid malignancy assessment may include certain ultrasound features. The analysis is lacking for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). Our meta-analysis aimed to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. Based on twenty studies describing sonographic features of 10,215 nodules, we found that the most crucial feature associated with an increased risk of FTC were tumor protrusion (odds ratios—OR = 10.19), microcalcifications or mixed type of calcifications: 6.09, irregular margins: 5.11, marked hypoechogenicity: 4.59, and irregular shape: 3.6. Abstract Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type.
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Qi Q, Zhou A, Guo S, Huang X, Chen S, Li Y, Xu P. Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study. Front Endocrinol (Lausanne) 2021; 12:763897. [PMID: 34777258 PMCID: PMC8578891 DOI: 10.3389/fendo.2021.763897] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To explore the characteristics of C-TIRADS by comparing it with ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS and EU-TIRADS. METHODS A total of 1096 nodules were collected from 884 patients undergoing thyroidectomy in our center between May 2018 and December 2020. Divided the nodules into two groups: ">10mm" and "≤10mm". Ultrasound characteristics of each nodule were observed and recorded by 2 doctors, then classified based on ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS, EU-TIRADS, and C-TIRADS. RESULTS A total of 682 benign nodules cases (62.23%) and 414 malignant nodules cases (37.77%) were identified. The ICC value of each guideline was:0.937(ACR-TIRADS), 0.858(EU-IRADS), 0.811(Kwak-TIRADS), 0.835(KTA/KSThR-TIRADS) and 0.854(C-TIRADS). The nodule malignancy rates in the groups(Kwak-TIRADS 4B, C-TIRADS 4B、4C) of two sizes were significantly different (all p<0.05). There was no statistical difference in the other grades of two sizes (all p>0.05). Unnecessary biopsy rates were the lowest in C-TIRADS (49.02% p<0.001). Furthermore, Kwak-TIRADS had the highest sensitivity and NPV (89.9%, 91.0%, all p<0.05), while C-TIRADS had the highest specificity and PPV (82.3%, 69.2%, all p<0.05). C-TIRADS and Kwak-TIRADS had the highest accuracy (76.0%, 72.5%, P=0.071). The AUCs of the 5 guidelines were C-TIRADS(0.816, P<0.05), Kwak-TIRADS(0.789, P<0.05) KTA/KSThR-TIRADS and ACR-TIRADS(0.773, 0.763, P=0.305), EU-TIRADS(0.734, P<0.05). The AUCs of the five guidelines were not statistically different between "nodules>10mm" and "nodules ≤ 10mm" (all P>0.05). CONCLUSIONS All five guides showed excellent interobserver agreement. C-TIRADS was slightly efficient than Kwak-IRADS, KTA/KSThR-TIRADS and ACR-TIRADS, and had greater advantages than EU-TIRADS. The diagnostic abilities of the five guidelines for "nodules ≤ 10mm" were not inferior to that of "nodules> 10mm". C-TIRADS is simple and easy to implement and can provide effective thyroid tumor risk stratification for thyroid nodule diagnosis, especially in China.
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