Implementation of Evidence-Based Guidelines for Thyroid Nodule Biopsy: A Model for Establishment of Practice Standards

Hambly, Niamh; Gönen, Mithat; Gerst, Scott R.; Duan, Li; Jia, Xiaoyu; Mironov, Svetlana; Sarasohn, Debra; Fleming, Stephen E.; Hann, Lucy E.

doi:10.2214/ajr.10.4577

Cited by 60 publications

(53 citation statements)

References 27 publications

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“…Regarding reproducibility, Hambly et al (24) studied the interobserver agreement of a five-point malignancy rating scale very similar to the TI-RADS score on 101 nodules. The interobserver agreement on whether to proceed to biopsy was fair to substantial, ranging from a k value of 0.38-0.69.…”

Section: Enhance Interobserver Agreementmentioning

confidence: 99%

Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography

Russ¹,

Royer²,

Bigorgne³

et al. 2013

European Journal of Endocrinology

281

236

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Objective: To evaluate prospectively the diagnostic accuracy of the thyroid imaging reporting and data system (TI-RADS) and its interobserver agreement and to estimate the reduction of indications of fineneedle aspiration biopsies (FNABs). Design: A prospective comparative study was designed. Methods: In 2 years, 4550 nodules in 3543 patients were prospectively scored using a flowchart and a six-point scale and then submitted to US-FNAB. Results were read according to the Bethesda system. Histopathological results were available for 263 cases after surgery. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value, and accuracy were calculated for the gray-scale score, elastography, and a combination of both methods. Interobserver agreement was calculated using the kappa statistic. The reduction in the number of FNABs was estimated. Results: When compared with cytopathological results, sensitivity, specificity, NPV, and accuracy were 95.7, 61, 99.7, and 62% for the TI-RADS gray-scale score; 74.2, 91.1, 98, and 90% for elastography; and 98.5, 44.7, 99.8, and 48.3% for a combination of both methods respectively. When compared with histopathological results, the sensitivity of the gray-scale score, elastography, and a combination of both methods were 93.2, 41.9, and 96.7% respectively. Interobserver agreement for the six-point scale and the recommendation for biopsy were substantial (k valueZ0.72 and 0.76 respectively). The reduction in the number of FNABs was estimated to be 33.8%. Conclusion: The TI-RADS score has high sensitivity and NPV for the diagnosis of thyroid carcinoma. A hard nodule should always be considered as suspicious for malignancy but elastography cannot be used alone. Combination of elastography with gray-scale can be used to improve sensitivity or specificity. Interobserver agreement and decrease in unnecessary biopsies are significant.

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Section: Enhance Interobserver Agreementmentioning

confidence: 99%

Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography

Russ¹,

Royer²,

Bigorgne³

et al. 2013

European Journal of Endocrinology

281

236

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“…Thyroid ultrasonography is an extremely sensitive tool for the diagnosis of thyroid nodules and may be specific in diagnosing papillary thyroid cancer (Cesur et al 2006, Hambly et al 2011. Moreover, this imaging modality aids the decision-making processes of which nodules to target for fine needle aspiration biopsy (FNAB) and increases the diagnostic yield of thyroid cell sampling (Perros et al 2014, American Cancer Society 2015, Pitoia & Miyauchi 2015.…”

Section: Current Diagnostic Approaches and Limitationsmentioning

confidence: 99%

“…Moreover, this imaging modality aids the decision-making processes of which nodules to target for fine needle aspiration biopsy (FNAB) and increases the diagnostic yield of thyroid cell sampling (Perros et al 2014, American Cancer Society 2015, Pitoia & Miyauchi 2015. Multiple studies have confirmed typical sonographic features associated with increased risks of (Table 2) (Frates et al 2005, Hambly et al 2011, Lee et al 2011, and current guidelines now recommend the use of a combination of these features in algorithms predicting the likelihood of thyroid malignancy as well as the selection of nodules requiring FNAB (Perros et al 2014, Haugen et al 2015, Pitoia & Miyauchi 2015. Highresolution ultrasonography by an experienced operator is highly recommended in the initial evaluation of patients with thyroid nodules.…”

Section: Current Diagnostic Approaches and Limitationsmentioning

confidence: 99%

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

Nieto¹,

Boelaert²

2016

Endocrine-Related Cancer

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Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring.

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“…Third, previously suggested malignant US features may have different predictive values for malignancy depending on nodule characteristics such as echogenicity, which has not been clarified. Although several studies [13][14][15][16][17][18][19] have suggested scoring or categorization systems for malignancy risk, this is not firmly established, and some of the suggested systems are fairly complicated and less reproducible in clinical practice. Therefore, there is still a need to establish a reliable and practical US-based risk stratification system for thyroid malignancy.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Based Risk Stratification for Malignancy in Thyroid Nodules: A Four-Tier Categorization System

Seo

Na²,

Kim

et al. 2015

Eur Radiol

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Implementation of Evidence-Based Guidelines for Thyroid Nodule Biopsy: A Model for Establishment of Practice Standards

Abstract: Our study illustrates a method to evaluate the standard of practice for thyroid nodule assessment among radiologists within an ultrasound group. Application of a 5-point malignancy rating scale to select nodules for biopsy is feasible and shows good diagnostic accuracy.

Cited by 60 publications

References 27 publications

Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography

Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

Ultrasound-Based Risk Stratification for Malignancy in Thyroid Nodules: A Four-Tier Categorization System

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