Cytologically indeterminate thyroid nodules: increased diagnostic performance with combination of US TI-RADS and a new scoring system

He, Yaping; Xu, Hui‐Xiong; Zhao, Chong‐Ke; Sun, Liping; Li, Xiaolong; Yue, Wenwen; Guo, Le‐Hang; Wang, Dan; Ren, Weiwei; Wang, Qiao; Qu, Shen

doi:10.1038/s41598-017-07353-y

Cited by 28 publications

(18 citation statements)

References 36 publications

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“…Age and nodule size are also important predictors of malignancy. We found that patients with malignant nodules were younger than those with benign nodules, consistent with the results of previous studies ( 14 , 43 , 44 ). The research by Kwong et al .…”

Section: Discussionsupporting

confidence: 92%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhu

et al. 2020

Endocrine Connections

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Purpose: To determine the diagnostic efficiency of the ATA classification and ultrasound-guided fine-needle aspiration (FNA) results in identifying the risk factors of malignancy, we analyzed the thyroid nodules of patients who underwent thyroidectomy and compared preoperative ATA classifications with FNA results. Methods: We retrospectively analyzed 274 nodules of 196 patients who underwent ultrasonography, FNA and thyroidectomy. Histopathological findings of thyroid nodules were considered as the gold standard in the analysis of the diagnostic efficiency of the ATA classification and FNA results. Univariate analysis and binary multivariate logistic regression analysis were applied to identify the ultrasound features associated with malignancy. Results: The overall malignancy rate of 274 nodules was 41.6%. The areas under the ROC curves (AUCs) for the ATA classification and FNA results were 0.88 and 0.878, respectively (P<0.001). The sensitivity and specificity of the ATA classification were 86% and 86.9%, whereas those of FNA results were 68.5% and 91.4%, respectively. The specificity (98.7%) and sensitivity (94.3%) increased after the combined use of the ATA classification and FNA results. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy. Microcalcifications had the highest OR (7.58), and taller-than-wide shape had the highest specificity in BSRTC I, II, III and IV cytologies. Conclusion: The diagnostic efficiency of the ATA classification and FNA results in identifying malignant nodules was high, and the use of both criteria improved the diagnostic accuracy. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhu

et al. 2020

Endocrine Connections

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“…Representatively, Choi et al [9] developed a web-based scoring risk stratification system using US characteristics. The TIRADSalso has been recently combined with cytology or scoring systems in management of indeterminate nodules [28, 29]. Therefore, we hypothesized combining TIRADS with variable echogenic foci would demonstrate promising capacity to distinguish thyroid malignancy with clinical importance.…”

Section: Discussionmentioning

confidence: 99%

Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci

Chung

Ahn

et al. 2019

BMC Med Imaging

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Background The malignancy risks of various echogenic foci in thyroid nodules are not consistent. The association between malignancy and echogenic foci and various Thyroid Imaging Reporting and Data System (TIRADS) in thyroid nodules has not been evaluated. We evaluated the malignancy probability and diagnostic performance of thyroid nodules with various echogenic foci and in combination with TIRADS. Methods This retrospective study was approved by Institutional Review Board. The data were retrospectively collected from January 2013 to December 2014. In total, 954 patients (mean age, 50.8 years; range, 13–86 years) with 1112 nodules were included. Using χ 2 test, we determined the prevalence of benign and malignant nodules among those with and without echogenic foci; we associated each of 6 echogenic foci types with benign and malignant nodules. Diagnostic performance was compared between the 6 types alone and in combination with various TIRADS. Results Among 1112 nodules, 390 nodules (35.1%) were found to have echogenic foci, and 722 nodules (64.9%) were not. Among nodules with echogenic foci, 254 nodules (65.1%) were malignant. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Our study demonstrated relatively low PPV (33.3–56.4%) in nodules with large echogenic foci without shadowing, macrocalcification, and peripheral curvilinear or eggshell echogenic foci with or without shadowing. However, when combined with high suspicion category of TIRADS, PPV increased to 50.0–90.9%. Conclusion Combination with TIRADS with different types of echogenic foci offer better stratification of the malignancy risk. Electronic supplementary material The online version of this article (10.1186/s12880-019-0328-2) contains supplementary material, which is available to authorized users.

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“…The halo sign is a nonspecific manifestation of a mummified nodule. Experts have differing opinions regarding the value of the halo sign in distinguishing benign from malignant nodules [10][11][12][13][14]. Lacout et al [6] considered that the halo sign is related to the development of tissue granulation and the formation of a fibrous capsule.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing mummified thyroid nodules from malignant thyroid nodules

2019

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Aim: To study the ultrasonographic (US) differences between “mummified” thyroid nodules and malignant thyroid nodules in order to achieve a more accurate imaging-based diagnosis and to avoid unnecessary biopsy.Material and methods: We retrospectively reviewed the US features of mummified thyroid nodules, as confirmed by fine-needle aspiration cytology (FNAC), in 193 cases. The US features included content, echo, shape, margin, microcalcification, suspicious lymph nodes and some characteristic features, including the cystic wall shrinkage sign, the concentric configuration or finger sign, calcification and halo. All of these features were classified and compared with those of 109 malignant lesions. The changes of these mummified nodules during the follow-up period were also examined.Results: The cystic wall shrinkage sign and the concentric configuration or finger sign were highly specific indicators of mummified thyroid nodules and could be used to distinguish mummified nodules from thyroid cancer with a specificity of 91.7% and 99.9%, respectively. A continuous decrease in the cyst size was observed during follow-up.Conclusions: Mummified thyroid nodules are characterized by the cystic wall shrinkage sign and the concentric configuration or finger sign on US and a continuous decrease in size during follow-up. These features may be useful for the differential imaging-based diagnosis of mummified versus malignant thyroid nodules.

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Cytologically indeterminate thyroid nodules: increased diagnostic performance with combination of US TI-RADS and a new scoring system

Cited by 28 publications

References 36 publications

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

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

Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci

Distinguishing mummified thyroid nodules from malignant thyroid nodules

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