Diagnostic performances and unnecessary US-FNA rates of various TIRADS after application of equal size thresholds

Huh, Sun-Chul; Lee, Hye Sun; Yoon, Jungmin; Kim, Min Jung; Moon, Hee Jung; Yoon, Jung Hyun; Park, Vivian Youngjean; Kwak, Jin Young

doi:10.1038/s41598-020-67543-z

Cited by 24 publications

(40 citation statements)

References 27 publications

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“…As per previous studies relying on the ACR-TIRADS class, FNA would be indicated in a range of 17% to 40%; in this paper, cases with FNA indicated by the ACR system accounted for 46.5% of the nodules, confirming its high “rule-out” role. The ancillary FNA rate was 28.5%, which is significantly lower than the results reported in the literature (63.8%) [ 4 ]. Some limitations of our study should be noted.…”

Section: Discussioncontrasting

confidence: 59%

“…Although the bioptic procedure is safe with rare complications, the application of TIRADS scores as an ancillary tool may improve the triage with a more efficient clinical management, postponing the performance of FNA in low-risk cases [ 11 , 12 ]. The ACR-TIRADS method was chosen in our study due to its putative superior overall performance [ 4 , 13 , 14 , 15 , 16 ]. Indeed, the other available and widely used US-based evaluation systems (ATA and EU-TIRADS) mainly rely on the assessment of nodules’ features (e.g., shape, margins and echogenicity) without the attribution of a score for each of these characteristics, representing purely pattern-based classifications.…”

Section: Discussionmentioning

confidence: 99%

“…Among the “pattern”-based methods, the American Thyroid Association (ATA) and the European Thyroid Association (EU-TIRADS) ones probably represent the most widely employed, and consist in the recognition of high risk and pretty qualitative criteria (such as nodule composition, echogenicity, margins, shape and calcifications), without a quantification scale that can ensure adequate inter-observer reproducibility [ 3 , 4 , 5 ]. Although these systems are largely employed in different countries, the most widely used US-based system is probably still represented by the American College of Radiology (ACR)-TIRADS one, a point scale option that allows one to readily “quantify” the level of risk for each lesion, representing a reliable alternative with practical feasibility [ 4 , 6 ]. For this reason, and for its relevance in routine clinical practice, this numerical ACR-TIRADS scoring system was selected to evaluate its role as a screening tool in a general hospital with a high prevalence of benign nodules.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

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Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

View full text Add to dashboard Cite

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“…Various studies have shown the good performance of ACR-TIRADS in selecting thyroid nodules deserving FNA, stressing its high "rule-out" role, as confirmed by our group here and previous experience [1,6,8,[16][17][18]. In the present work, the ACR and EU-TIRADS systems recommended FNA in 46.5% (223/480) and 51.9% (249/480) of the nodules, respectively.…”

Section: Discussionsupporting

confidence: 84%

“…In the international scenario, different alternative ultrasound (US) algorithms have been proposed for characterizing thyroid nodules [1]. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data Systems (TIRADS) consists of a scale with increasing scores for specific US features of thyroid nodules and is able to stratify lesions with a progressively higher risk of malignancy (ROM) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Seminati

Capitoli

Leni

et al. 2021

Cancers

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Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.

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Inter‐Rater Reliability of Thyroid Ultrasound Risk Criteria: A Systematic Review and Meta‐Analysis

et al. 2022

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Objective: The most commonly employed diagnostic criteria for identifying thyroid nodules include Thyroid Imaging and Reporting Data System (TI-RADS) and American Thyroid Association (ATA) guidelines. The purpose of this systematic review and meta-analysis is to determine the inter-rater reliability of thyroid ultrasound criteria.Methods: We performed a library search of MEDLINE (Ovid), EMBASE (Ovid), and Web of Science for full-text articles published from January 2005 to June 2022. We included full-text primary research articles that used TI-RADS and/or ATA guidelines to evaluate thyroid nodules in adults. These included studies must have calculated inter-rater reliability using any validated metric. The Quality Appraisal for Reliability Studies (QAREL) was used to assess study quality. We planned for a random-effects meta-analysis, in addition to covariate and publication bias analyses. This study was performed in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines and registered prior to conduction (International prospective register of systematic reviews-PROSPERO: CRD42021275072).Results: Of the 951 articles identified via the database search, 35 met eligibility criteria. All studies were observational. The most commonly utilized criteria were ACR Thyroid Imaging and Reporting Data System (TI-RADS) and/or ATA criteria, while the majority of studies employed Κ statistics. For ACR TI-RADS, the pooled Κ was 0.51 (95% confidence interval [CI]: 0.42, 0.57; n = 7) while for ATA, the pooled Κ was 0.52 (95% CI: 0.37, 0.67; n = 3). Due to the small number of studies, covariate or publication bias analyses were not performed.Conclusion: Ultrasound criteria demonstrate moderate inter-rater reliability, but these findings are impacted by poor study quality and a lack of standardization.

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Diagnostic performances and unnecessary US-FNA rates of various TIRADS after application of equal size thresholds

Cited by 24 publications

References 27 publications

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Inter‐Rater Reliability of Thyroid Ultrasound Risk Criteria: A Systematic Review and Meta‐Analysis

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