Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines

Wu, Xiaoli; Du, Jiarui; Wang, Hui; Jin, Chunxiang; Sui, Guoqing; Yang, Dejun; Lin, Yuanqiang; Luo, Qiang; Fu, Ping; Li, Hequn; Teng, Dengke

doi:10.1007/s12020-019-01886-0

Cited by 46 publications

(40 citation statements)

References 28 publications

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“…Although this evidence is based on two studies, these findings concur with some studies that indicated ATA- and KWAK-TIRADS have better diagnostic efficiency in comparison with other TIRADS systems in human visual assessment of thyroid nodules >1 cm [78,79,80]. Contrarily, some recent studies state that ACR-TIRADS has the lowest false-negative rate and is superior at reducing cases of unnecessary thyroid FNAC [81,82,83]. The differences in literature findings may be due to the differences in the criteria within the different TIRADS systems.…”

Section: Discussionsupporting

confidence: 82%

The Diagnostic Efficiency of Ultrasound Computer–Aided Diagnosis in Differentiating Thyroid Nodules: A Systematic Review and Narrative Synthesis

Chambara

Ying

2019

Cancers

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Computer-aided diagnosis (CAD) techniques have emerged to complement qualitative assessment in the diagnosis of benign and malignant thyroid nodules. The aim of this review was to summarize the current evidence on the diagnostic performance of various ultrasound CAD in characterizing thyroid nodules. PUBMED, EMBASE and Cochrane databases were searched for studies published until August 2019. The Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool was used to assess the methodological quality of the studies. Reported diagnostic performance data were analyzed and discussed. Fourteen studies with 2232 patients and 2675 thyroid nodules met the inclusion criteria. The study quality based on QUADAS-2 assessment was moderate. At best performance, grey scale CAD had a sensitivity of 96.7% while Doppler CAD was 90%. Combined techniques of qualitative grey scale features and Doppler CAD assessment resulted in overall increased sensitivity (92%) and optimal specificity (85.1%). The experience of the CAD user, nodule size and the thyroid malignancy risk stratification system used for interpretation were the main potential factors affecting diagnostic performance outcomes. The diagnostic performance of CAD of thyroid ultrasound is comparable to that of qualitative visual assessment; however, combined techniques have the potential for better optimized diagnostic accuracy.

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Section: Discussionsupporting

confidence: 82%

The Diagnostic Efficiency of Ultrasound Computer–Aided Diagnosis in Differentiating Thyroid Nodules: A Systematic Review and Narrative Synthesis

Chambara

Ying

2019

Cancers

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“…However, multiple studies have found that the ATA guidelines have a higher sensitivity, greater negative predictive value, and similar overall diagnostic performance when compared to the ACR-TIRADS. 29,30 When applying the ATA risk stratification methods in our study, only one patient with malignant final pathology had characteristics consistent with the high suspicion classification, and this classification was not significantly associated with malignancy on regression analysis. Therefore, ultrasound interpretation did not contribute to the reliability of FNAB in this study, highlighting the benefit of incorporating an objective modifier such as age.…”

Section: Discussionmentioning

confidence: 64%

Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

Sutton

Canner

Rooper

et al. 2021

The American Journal of Surgery

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Background: Current data regarding the risk of malignancy in a large thyroid nodule with benign fineneedle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules4 cm with benign cytology. Methods: We performed a single-institution retrospective review of patients who underwent surgery from 07/2008e08/2019 for a cytologically benign thyroid nodule 4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression. Results: Of 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients 55. Patient age 55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1e0.7,p ¼ 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7e1.4,p ¼ 0.980, and OR:9.6,95%CI:0.9e107.8,p ¼ 0.066, respectively). Conclusions: Patients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule4 cm.

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“…A non-significant difference in the rate of detection of thyroid cancer was noted, favoring the ATA guidelines (97% v 91%; P=0.180). As expected, this was due to a lower number of FNAs recommended by TIRADS (482 v 582 for ATA), with a rate of unnecessary FNAs of 23% for ACR-TIRADS and 35% for ATA 108. However, the definition of unnecessary biopsies was based on a benign result; clinically, other factors might justify the need for biopsy.…”

Section: Estimating the Risk Of Thyroid Cancer And Need For Thyroid Bmentioning

confidence: 70%

“…Subsequent studies used a combined assessment of ultrasound features either qualitatively or quantitatively to develop ultrasound risk stratification systems that can estimate the prevalence of malignancy (POM) (table 4 and table 5). 4593949596979899100101102103104105106107108109110111…”

Section: Estimating the Risk Of Thyroid Cancer And Need For Thyroid Bmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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Comparison and preliminary discussion of the reasons for the differences in diagnostic performance and unnecessary FNA biopsies between the ACR TIRADS and 2015 ATA guidelines

Cited by 46 publications

References 28 publications

The Diagnostic Efficiency of Ultrasound Computer–Aided Diagnosis in Differentiating Thyroid Nodules: A Systematic Review and Narrative Synthesis

The Diagnostic Efficiency of Ultrasound Computer–Aided Diagnosis in Differentiating Thyroid Nodules: A Systematic Review and Narrative Synthesis

Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

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