American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool

Garber, Jeffrey R.; Papini, Enrico; Frasoldati, Andrea; Lupo, Mark A.; Harrell, R. Mack; Parangi, Sareh; Patkar, Vivek; Baloch, Zubair W.; Pessah-Pollack, Rachel; Crescenzi, Anna; Lubitz, Carrie C.; Paschke, Ralf; Randolph, Gregory W.; Guglielmi, Rinaldo; Lombardi, Celestino Pio; Gharib, Hossein

doi:10.1016/j.eprac.2021.04.007

Cited by 26 publications

(14 citation statements)

References 35 publications

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“…Several studies have addressed the role of clinical risk factors, such as patient age, sex, and presence of solitary nodule, as independent predictors of malignancy, supporting the concept that the decision to perform FNA should be made based on the US features combined with clinical evaluation. 12,14,[24][25][26] In our series, the nodular median size was 2.6 cm (range: 1.9-4.0 cm), which is slightly bigger than previous data 11,25,27 with over half benign nodules (55.4%) measuring >2.5 cm. Also, 71.8% of patients had two or more nodules.…”

Section: Discussioncontrasting

confidence: 74%

A prospective comparison of ACR‐TIRADS and EU‐TIRADS in thyroid nodule assessment for FNA‐US

Eidt

Oliveira

Lagos

et al. 2022

Clinical Endocrinology

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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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Section: Discussioncontrasting

confidence: 74%

A prospective comparison of ACR‐TIRADS and EU‐TIRADS in thyroid nodule assessment for FNA‐US

Eidt

Oliveira

Lagos

et al. 2022

Clinical Endocrinology

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“…Efforts have been made to reduce the number of nonindicated thyroid ultrasonography performed in the US-eg, through the Choosing Wisely campaign 23 and guidelines developed to reduce interventions for low-risk thyroid nodules. [24][25][26][27] Pathologic analysis of the thyroidectomy specimens revealed a cancer in 46% of cases. Nearly half of these cancer cases were discovered in the absence of symptoms referable to the thyroid gland.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection Modes

Sajisevi

Caulley

Eskander

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThere is epidemiologic evidence that the increasing incidence of thyroid cancer is associated with subclinical disease detection. Evidence for a true increase in thyroid cancer incidence has also been identified. However, a true increase in disease would likely be heralded by an increased incidence of thyroid-referable symptoms in patients presenting with disease.OBJECTIVES To evaluate whether modes of detection (MODs) used to identify thyroid nodules for surgical removal have changed compared with historic data and to determine if MODs vary by geographic location. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective analysis of pathology and medical records of 1328 patients who underwent thyroid-directed surgery in 16 centers in 4 countries: 4 centers in Canada, 1 in Denmark, 1 in South Africa, and 12 in the US. The participants were the first 100 patients (or the largest number available) at each center who had thyroid surgery in 2019. The MOD of the thyroid finding that required surgery was classified using an updated version of a previously validated tool as endocrine condition, symptomatic thyroid, surveillance, or without thyroid-referable symptoms (asymptomatic). If asymptomatic, the MOD was further classified as clinician screening examination, patient-requested screening, radiologic serendipity, or diagnostic cascade. MAIN OUTCOMES AND MEASURESThe MOD of thyroid nodules that were surgically removed, by geographic variation; and the proportion and size of thyroid cancers discovered in patients without thyroid-referable symptoms compared with symptomatic detection. Data analyses were performed from April 2021 to February 2022. RESULTSOf the 1328 patients (mean [SD] age, 52 [15] years; 993 [75%] women; race/ethnicity data were not collected) who underwent thyroid surgery that met inclusion criteria, 34% (448) of the surgeries were for patients with thyroid-related symptoms, 41% (542) for thyroid findings discovered without thyroid-referable symptoms, 14% (184) for endocrine conditions, and 12% (154) for nodules with original MOD unknown (under surveillance). Cancer was detected in 613 (46%) patients; of these, 30% (183 patients) were symptomatic and 51% (310 patients) had no thyroid-referable symptoms. The mean (SD) size of the cancers identified in the symptomatic group was 3.2 (2.1) cm (median [range] cm, 2.6 [0.2-10.5]; 95% CI, 2.91-3.52) and in the asymptomatic group, 2.1 (1.4) cm (median [range] cm, 1.7 [0.05-8.8]; 95% CI, 1.92-2.23). The MOD patterns were significantly different among all participating countries.CONCLUSIONS AND RELEVANCE This retrospective analysis found that most thyroid cancers were discovered in patients who had no thyroid-referable symptoms; on average, these cancers were smaller than symptomatic thyroid cancers. Still, some asymptomatic cancers were large, consistent with historic data. The substantial difference in MOD patterns among the 4 countries suggests extensive variations in practice.

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“…Readily identifiable variables at the point of care such as age, sex, nodule size and nodule location have more recently been shown to impact cancer risk assessment in a nodule population (3,7). Mathematical models have also been validated to allow for multivariate risk assessment and demonstrates how such variables can help modify cancer risk (3,8).…”

Section: Introductionmentioning

confidence: 99%

Point of Care Measurement of Body Mass Index and Thyroid Nodule Malignancy Risk Assessment

et al. 2022

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BackgroundLarge scale epidemiology studies have suggested obesity may increase the risk of thyroid cancer, though no prospective analyses using real-world measurement of BMI at a time proximate to initial thyroid nodule evaluation have been performed.MethodsWe performed a prospective, cohort analysis over 3 years of consecutive patients presenting for thyroid nodule evaluation. We measured BMI proximate to the time of initial evaluation and correlated this with the final diagnosis of benign or malignant disease. We further correlated patient BMI with aggressivity of thyroid cancer, if detected.ResultsAmong 1,259 consecutive patients with clinically relevant nodules, 199(15%) were malignant. BMI averaged 28.6 kg/m2 (SD: 6.35, range:16.46-59.26). There was no correlation between the measurement of BMI and risk of thyroid cancer (p=0.58) as mean BMI was 28.9 kg/m2 and 28.6 kg/m2 in cancerous and benign cohorts, respectively. Similarly, BMI did not predict aggressive thyroid cancer (p=0.15). While overall nodule size was associated with increased BMI (p<0.01), these data require further validation as obesity may hinder nodule detection until large.ConclusionIn contrast to findings published from large scale association studies drawn from national databases, these prospective data of consecutive patients presenting for nodule evaluation detect no association of obesity (as measured by BMI) with thyroid cancer. Real time measurement of BMI at the time of thyroid nodule evaluation does not contribute to cancer risk assessment.

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American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool

Cited by 26 publications

References 35 publications

A prospective comparison of ACR‐TIRADS and EU‐TIRADS in thyroid nodule assessment for FNA‐US

A prospective comparison of ACR‐TIRADS and EU‐TIRADS in thyroid nodule assessment for FNA‐US

Evaluating the Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection Modes

Point of Care Measurement of Body Mass Index and Thyroid Nodule Malignancy Risk Assessment

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