A Proposal to Stratify the Intermediate-Risk Thyroid Nodules According to the AACE/ACE/AME Guidelines with Ultrasound Features

Abstract

To propose a risk stratification system for intermediate-risk thyroid nodules (TNs) according to American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi Medical (AACE/ACE/AME) Guideline with ultrasound (US) features. 1000 patients with 1000 nodules (902 benign nodules and 98 malignant nodules) were included. All the nodules were confirmed with either fine needle aspiration (FNA) cytology and follow-up or histology results after surgery. Univariate analysis and binary multivariate logic regression analysis were applied to analyze the possible risk US features associated with malignancy. Receiver operating characteristic curves (ROC) were drew and compared. Univariate analysis and binary multivariate logistic regression analysis showed that indeterminate hyper-echoic spot (OR = 4.544), slightly ill-defined margin (OR = 2.559), slight hyper-echogenicity (OR = 1.992) and no macro-calcification (OR = 1.921) were risk factors for the intermediate-risk thyroid nodules (TNs). A predicting model was established based on the 4 risk factors. The risk rates of malignancy were 5.7% (26/455) in Stage I, 11.0% (49/445) in Stage II, 23.1% (21/91) in Stage III, 33.3% (3/9) in Stage IV. In conclusion, for the intermediate-risk TNs, special attention should be paid to the TNs with indeterminate hyper-echoic spot, slightly ill-defined margin, slight hyper-echogenicity, or no macro-calcification. The probability of malignancy increased with the number of risk factors increasing.

Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

“…In some cases, an approach that combines different ancillary techniques has proved to offer greater diagnostic accuracy than a single technique alone [ 18 , 36 – 39 ]. As reported in previous studies [ 15 – 17 , 40 ], our data confirmed the role of conventional ultrasound as the basis for the assessment, owing to its advantages in terms of cost and time. However, the need for a scoring system that performs better than the separate evaluation of single items is increasingly evident.…”

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

“…Recent studies have indicated that no single ultrasound feature can directly and accurately predict the malignancy of a nodule ( 36 , 37 ); however, some characteristics, such as hypoechogenicity, irregular margins, taller-than-wide shape, microcalcifications and solidity, may predict thyroid cancer ( 14 , 16 , 17 , 19 , 20 , 38 ). In this study, solidity, hypoechogenicity, irregular margins, taller-than-wide shape, microcalcifications and posterior echo attenuation associated with malignant nodules, whereas regular halo associated with benign nodules.…”

“…In addition, ultrasonography can guide FNA, which can reduce the generation of non-diagnostic specimens. Ultrasound features, such as solidity, hypoechogenicity, microcalcifications, taller-than-wide shape and irregular margins, are useful in the diagnosis of malignant nodules ( 13 , 14 , 15 , 16 , 17 , 18 ). Furthermore, other studies have reported that a simple cystic and spongiform appearance have a higher negative predictive value (NPV) for malignancy ( 13 , 19 , 20 ).…”

Ultrasound Characterization of a Solitary Thyroid Nodule According to British Thyroid Association (BTA) - Derived Criteria: A Simple Test of Reliability on a Small Cohort

“…Another promising system, developed by the British Thyroid Association (BTA), was introduced to the 2014 guidelines on the management of thyroid cancer. The recommendation aims to stratify thyroid nodules as benign, suspicious or malignant based on ultrasound appearances termed U1-U5 [25] . It considers the following US features as predictors of malignancy: Eccentric location of the solid portion in a partially cystic nodule, the nonsmooth margins, the hypo-echogenicity of the solid portion, micro-calcifications, and "Taller-thanwide" shape [24] .…”

“…These images are assumed to make it easier for more recognition of different morphological patterns and thus easier imaging practice. The system presents the morphological class with no numerical scoring system and size is not included in criteria [25] . These graphic references are supposed to encourage the sonographer to translate his findings into a particular degree of concern, thus allowing for a common "Thyroid language" among health care professionals to communicate ultrasound findings.…”