Arambewela MH, Wijesinghe AM, Randhawa K, Bull M, Wadsley J, Balasubramanian SP. A pragmatic assessment of the British Thyroid Association "U classification" of thyroid nodules with a focus on their follow-up.
Clin Radiol 2020;
75:466-473. [PMID:
32184000 DOI:
10.1016/j.crad.2020.02.012]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
AIM
To assess the predictive value of the U classification and the significance of follow-up ultrasound in those managed conservatively.
MATERIALS AND METHODS
A retrospective observational study was carried out among 1,465 patients who underwent thyroid ultrasound in 2016 at a teaching hospital in UK. Details regarding U classification of nodules, cytology, histology in patients who underwent surgery, and follow-up ultrasound in those managed conservatively were obtained.
RESULTS
Thyroid surgery was performed in 129 patients of which malignancy was seen in 35 (27.1%). The proportion of patients with cancer in U1-U5 categories were 0%, 13.6%, 30.4%, 40%, and 100%, respectively (Fisher's exact test p=0.001). There was no significant difference in U stage, cytology, or histology between incidental and symptomatic nodules. Among patients who did not undergo surgery 5% of U1, 14.6% of U2, 75% of U3, and 71.4% of U4 underwent repeat ultrasound. Radiological progression in nodule size was seen in 4.2% of U1, 1.9% of U2, 0% of U3, and 40% of U4 nodules at median duration of 306, 439, 274, and 748 days, respectively.
CONCLUSIONS
U classification is reliable in risk-stratifying thyroid nodules. Patients with benign nodules without high-risk features do not require follow-up. The interval between scans in patients with indeterminate nodules can be extended to a period of 6-12 months.
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