A pragmatic assessment of the British Thyroid Association “U classification” of thyroid nodules with a focus on their follow-up

Arambewela, Maulee Hiromi; Wijesinghe, A.M.; Randhawa, Karandeep S; Bull, Matthew; Wadsley, Jonathan; Balasubramanian, Sabapathy P

doi:10.1016/j.crad.2020.02.012

Cited by 6 publications

(5 citation statements)

References 30 publications

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“… 5 A recent study demonstrated the reliability of the BTA classification although it remained undefined as to the appropriate interval and duration of follow-up for indeterminate nodules without high-risk cytology or clinical features. 7 An earlier validation study found it to be a robust method but only a small proportion of studied nodules had cytological or histological correlation. 8 …”

Section: Introductionmentioning

confidence: 99%

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Watkins

O'Neill

Young

et al. 2021

The British Journal of Radiology

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Objectives: To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary FNA rates. Methods: 218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound (US) images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for fine needle aspiration (FNA). Results: 77 (35.3%) nodules were malignant. Deeming US Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilizing BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001. Conclusion: BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering US Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA. Advances in knowledge: BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA. Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS Ultrasound Grading Systems with Histological Correlation: Diagnostic Performance for Predicting Thyroid Malignancy and Unnecessary Fine Needle Aspiration Biopsy Rate

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Section: Introductionmentioning

confidence: 99%

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Watkins

O'Neill

Young

et al. 2021

The British Journal of Radiology

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“…The percentages of patients with cancer classified as ‘U1’ (benign with a normal thyroid gland), ‘U2’ (benign thyroid nodule), ‘U3’ (indeterminate), ‘U4’ (suspicious thyroid nodule) and ‘U5’ (malignant nodule) were 0 per cent, 13.6 per cent, 30.4 per cent, 40 per cent and 100 per cent, respectively. 25,26 In a study by Weller et al . comprising 73 patients with 17 histologically confirmed malignant nodules, the negative predictive value and sensitivity of the ‘U’ score was 100 per cent, and the specificity and positive predictive value was 34 per cent and 32 per cent respectively.…”

Section: Discussionmentioning

confidence: 99%

Can we better advise our patients with nodular thyroid disease?

et al. 2023

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Background The 2014 British Thyroid Association guidelines acknowledged the value of risk-stratifying thyroid nodules by utilising an ultrasound reporting system (‘U’ classification). This study assessed whether using pre-existing parameters in combination can better stratify patients’ malignancy and completion thyroidectomy risks. Method A multicentre, retrospective, observational review identified 936 NHS Greater Glasgow and Clyde patients from pathology records who underwent hemithyroidectomy between 1 January 2014 and 31 December 2019. Results A total of 308 patients had thyroid malignancy, 180 (58.4 per cent) progressed to completion thyroidectomy. A nodule classified as ‘U3’ (indeterminate) was associated with a 35.4 per cent chance of malignancy and a 21.6 per cent risk of requiring completion surgery. Amalgamation of ‘U’ score with Thy score enhanced risk prediction. The malignancy rate in U3, Thy-3f nodules was 38 per cent, and 21 per cent required completion surgery. The malignancy and completion thyroidectomy rates were comparatively lower for U3, Thy-3a nodules (22 per cent and 14.3 per cent, respectively). Conclusion Combining ultrasound ‘U’ score and Thy score improves pre-operative thyroid nodule risk stratification, leading to better informed patients regarding the risks of malignancy and completion surgery. A move towards an integrated assessment approach should be considered.

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“…Thyroid surgery was performed in 129 patients, of which malignancy was seen in 35 (27.1%). The proportions of patients with cancer in U1-U5 categories were 0%, 13.6%, 30.4%, 40%, and 100%, respectively [4]. In another study of 73 consecutive patients with 17 histological confirmed malignant nodules, it was found that the sensitivity and NPV of BTA-U score in detecting and predicting malignancy were 100%, whereas the specificity and PPV were 34% and 32%, respectively [5].…”

Section: Chilean Tirads (2009)mentioning

confidence: 98%

The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls

Russ

Trimboli

Buffet

2021

Cancers

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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.

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A pragmatic assessment of the British Thyroid Association “U classification” of thyroid nodules with a focus on their follow-up

Cited by 6 publications

References 30 publications

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Can we better advise our patients with nodular thyroid disease?

The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls

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