Dataset Information

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms.

ABSTRACT:

Objectives

To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy.

Methods

Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system.

Results

The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511-0.611). The missed biopsy rates were 9.0-22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2-4 cm were 16.2-35.1% and 0-20.0%, respectively. Unnecessary biopsy rates were 65.3-93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2-89.7%.

Conclusion

The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms.

Key points

• Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

SUBMITTER: Lin Y

PROVIDER: S-EPMC9122875 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms.

Lin Yinghe Y Lai Shuiqing S Wang Peiqing P Li Jinlian J Chen Zhijiang Z Wang Long L Guan Haixia H Kuang Jian J

European radiology 20220101 6

<h4>Objectives</h4>To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy.<h4>Methods</h4>Three hundred twenty-nine follicular neoplasms with definitive postoperat ...[more]

PMID: 34973102

Similar Datasets

Project description:Background This study sought to investigate the applicability of different ultrasound (US) thyroid risk stratification systems in diagnosing medullary thyroid carcinoma (MTC) and determining the need for biopsy. Methods In total, 34 MTC nodules, 54 papillary thyroid carcinoma (PTC) nodules, and 62 benign thyroid nodules were examined in this study. All the diagnoses were histopathologically confirmed postoperatively. All the thyroid nodule sonographic features were recorded and categorized by 2 independent reviewers according to the Thyroid Imaging Reporting and Data System (TIRADS) of the American College of Radiology (ACR), the American Thyroid Association (ATA) guidelines, the European Thyroid Association (EU) TIRADS, the Kwak-TIRADS, and the Chinese TIRADS (C-TIRADS). The sonographic differences and risk stratifications of the MTCs, PTCs, and benign thyroid nodules were analyzed. The diagnostic performance and recommended biopsy rates for each classification system were evaluated. Results The risk stratifications of MTCs were all higher than the benign thyroid nodules (P<0.01) and lower than PTCs (P<0.01) with each classification system. Hypoechogenicity and malignant marginal features were independent risk factors for identifying malignant thyroid nodules, and the area under the receiver operating characteristic curve (AUC) for identifying MTCs was lower than that for identifying PTCs (0.873 vs. 0.954, respectively). The AUCs, sensitivity, specificity, positive predictive values, negative predictive values, and accuracy values of the 5 systems for MTC were all lower than those for PTC. The best cut-off values for diagnosing MTC were TIRADS (TR) 4 in the ACR-TIRADS, intermediate suspicion in the ATA guidelines, TR 4 in EU-TIRADS, and TR 4b in both the Kwak-TIRADS and the C-TIRADS. The Kwak-TIRADS had the highest recommended biopsy rate for MTCs (97.1%), followed by the ATA guidelines, the EU-TIRADS (88.2%), the C-TIRADS (85.3%), and the ACR-TIRADS (79.4%). Conclusions The US-based thyroid malignancy risk stratification systems analyzed in this study were able to satisfactorily identify MTC and recommend biopsy, but the diagnostic performance of these systems for MTC was not as good as that for PTC.

Project description:BackgroundThe lack of standardization in risk stratification systems (RSSs) has led to uncertainty in selecting the most effective RSS for diagnosing malignancy risk in thyroid nodules. Therefore, the aim of this study was to compare the diagnostic performance of four current score-based RSSs according to thyroid nodule size, with the goal of determining the most effective RSS and aiding in clinical decision-making.MethodsBetween July 2013 and January 2019, a total of 2,667 consecutive patients presenting with 3,944 thyroid nodules were pathologically diagnosed after thyroidectomy and/or ultrasound (US)-guided fine-needle aspiration (FNA). These nodules were retrospectively dichotomized into two groups: small nodules (<1 cm) and large nodules (≥1 cm). The four RSSs were used to assign US categories, and the diagnostic performances were computed and compared based on the size of thyroid nodules, both before and after the application of size thresholds for biopsy.ResultsAfter thyroidectomy or biopsy, 1,781 (45.2%) thyroid nodules were found to be malignant. (I) After applying size thresholds for biopsy in ≥1 cm nodules, the highest specificity, accuracy, area under the curve (AUC) and the lowest FNA rate and unnecessary FNA rate were observed in the Artificial Intelligence-Thyroid Imaging Reporting And Data System (AI-TIRADS) (66.1%, 75.3%, 0.785, 55.1%, and 38.6%, respectively, P<0.05 for all). (II) Before applying size thresholds for biopsy in ≥1 cm nodules, the FNA rate and unnecessary FNA rate of the four RSSs were lower they were after the application of the size threshold: American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), 59.1% versus 61.4%, 39.8% versus 45.4%; AI-TIRADS, 52.3% versus 55.1%, 34.0% versus 38.6%; TIRADS issued by Kwak et al. (Kwak-TIRADS), 52.5% versus 76.1%, 34.4% versus 52.1%; Chinese Thyroid Imaging Reporting and Data System (C-TIRADS), 51.5% versus 66.2%, 34.4% versus 50.1% (P<0.05 for all). (III) The small nodules showed higher sensitivity and lower specificity than the large nodules (ACR-TIRADS, 97.7% versus 95.5%, 46.2% versus 62.5%; AI-TIRADS, 97.2% versus 92.7%, 49.9% versus 71.6%; Kwak-TIRADS, 97.2% versus 92.5%, 49.7% versus 71.3%; C-TIRADS, 94.2% versus 90.7%, 55.0% versus 71.8%, respectively, all P<0.05).ConclusionsA potential effective strategy for managing large nodules in the current score-based RSSs could be to rely solely on US categories rather than size thresholds for biopsy. Additionally, the diagnostic performance of small nodules showed higher sensitivity and lower specificity compared to large nodules before applying size thresholds for biopsy. These findings suggest a possible new management strategy for large nodules and provide a basis for the managing small nodules.

Dataset Information

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms.

Objectives

Methods

Results

Conclusion

Key points

Publications

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets