Is there still a role for thyroid scintigraphy in the workup of a thyroid nodule in the era of fine needle aspiration cytology and molecular testing?

Moreno‐Reyes, Rodrigo; Kyrilli, Aglaia; Lytrivi, Maria; Bourmorck, C.; Chami, Rayan; Corvilain, Bernard

doi:10.12688/f1000research.7880.1

Cited by 18 publications

(7 citation statements)

References 56 publications

(49 reference statements)

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“…Nonetheless, scintigraphy is still the method of choice to assess the functional relevance of autonomous nodules and, thus, the risk to develop hyperthyroidism after exposure to high amounts of iodine. Our conclusion regarding the importance of scintigraphy agrees with publications by other authors (43)(44)(45)(46).…”

Section: Resultssupporting

confidence: 93%

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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Thyroid nodules are a common finding, especially in iodine-deficient regions. Ultrasonographic scoring systems such as Thyroid Imaging Reporting And Data System (TIRADS) are helpful in differentiating between benign and malignant thyroid nodules by offering a risk stratification model. Depending on the constellation or number of suspicious ultrasound features, a fine needle biopsy (FNB) is recommended. However, none of the previously published TIRADS considered the functional status of the nodules. Hyperfunctioning thyroid nodules (HTN) were presumed to exclude malignancy with a very high negative predictive value. Particularly in regions where the iodine supply is lower, the majority of HTN are seen in patients with normal TSH levels. Therefore, thyroid scintigraphy is essential for the detection of HTN. We investigated whether TIRADS identifies HTN as non-suspicious. We evaluated 615 HTN (23.2±10.0 mm at maximum diameter in 582 patients ( = 442 female, 57.7±13.2 years, and = 140 male, 60.1 ±12.7 years) detected byTc Pertechnetate or Iodine scintigraphy. Prior to evaluating the scintigraphic appearance, all nodules were analyzed prospectively with sonography, using the TIRADS model referenced in Kwak et al., wherein fine needle biopsy is recommended for TIRADS 4A or higher. We also investigated two subgroups, 42 nodules with available histology as well as 117 patients with subclinical or overt hyperthyroidism. Whereas 15.9% of the nodules were classified as TIRADS 3 or lower and <0.1% as TIRADS 5, most of the nodules were classified as TIRADS 4A (29.3%), 4B (29.3%), and 4C (24.9%), respectively. Altogether, more than 80% of the autonomous thyroid nodules were classified as TIRADS 4A or higher which would result in a recommendation of fine needle biopsy. Focusing on those 117 HTN that were already associated with hyperthyroid laboratory values, the rates were similar: 81.2% were categorized as TIRADS 4A or higher (4A: 33.3%, 4B: 29.9%, 4C:17.1%, 5: 0.9%). In the subgroup of patients who underwent thyroid surgery, all nodules were benign, confirming the known NPV of HTN with regard to malignancy exclusion. Integration of thyroid scintigraphy into the TIRADS model is essential to prevent unnecessary FNB and thyroid surgery.

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Section: Resultssupporting

confidence: 93%

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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“…Thirdly, only one study specifically excluded autonomous functioning thyroid nodules (AFTN) [37]. AFTN accounts for 5 to 10% of palpable nodules while is diagnosed in up to 20% of patients from iodine deficient regions [45,46]. Thyroid scintigraphy with either I-123-natrium iodide ( 123 I) or 99m Tc-pertechnetate is the only method to diagnose AFTN and is recommended by ATA guidelines in patients with low serum TSH [3].…”

Section: Discussionmentioning

confidence: 99%

Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

Castellana

Trimboli

Piccardo

et al. 2019

JCM

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Thyroid nodules with indeterminate fine-needle aspiration cytology (FNA) represent a major challenge in clinical practice. We conducted a systematic review and meta-analysis evaluating the ability of hybrid imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to appropriately select these nodules for surgery. PubMed, CENTRAL, Scopus, and Web of Science were searched until July 2019. Original articles reporting data on the performance of 18F-FDG PET/CT in thyroid nodules with indeterminate FNA were included. Summary operating points including 95% confidence interval values (95% CI) were estimated using a random-effects model. Out of 786 retrieved papers, eight studies evaluating 104 malignant and 327 benign thyroid nodules were included. The pooled positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT were 1.7 (95% CI: 1.4–2.0), 0.4 (95% CI: 0.2–0.7), and 3.5 (95% CI: 1.7–7.1), respectively. No heterogeneity was found for LR+ and DOR. In patients with thyroid nodules with indeterminate FNA, 18F-FDG PET/CT has a moderate ability to correctly discriminate malignant from benign lesions and could represent a reliable option to reduce unnecessary diagnostic surgeries. However, further studies using standardized criteria for interpretation are needed to confirm the reproducibility of these findings.

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“…The prevalence of malignancy among AFTNs is low, and indeed, AFTN is considered a benign entity in clinical practice 4,5,12 . AFTN accounts for 5%‐10% of palpable nodules, with a prevalence of about 20% in iodine‐deficient regions 12,13 . Thyroid scintigraphy (TS), with either 99mTc‐pertechnetate or I‐123‐natrium iodide (I‐123), is the only method of diagnosing AFTN and is recommended by the 2015 American Thyroid Association guidelines in patients with subnormal serum TSH 5 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

Castellana

Virili

Paone

et al. 2020

Clinical Endocrinology

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Objective Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine‐needle aspiration (FNA) biopsies in patients with thyroid nodules. Autonomously functioning thyroid nodules (AFTN) account for 5%‐10% of palpable lesions and are very rarely malignant. The present study was undertaken to investigate how RSSs classify AFTNs and whether RSSs are able to avoid unnecessary FNA biopsies in such cases. Methods Patients with AFTN who had undergone US, scintigraphy and thyroid function evaluation from December 2016 to December 2017 were selected. US images were retrospectively reviewed and AFTN reclassified according to AACE/ACE/AME, ACR‐TIRADS, ATA, BTA, EU‐TIRADS, K‐TIRADS and TIRADS. Risk class and indication for FNA were assessed. Results A number of 87 AFTNs from 85 consecutive patients were enrolled. A median diameter of 22 mm (range 10‐59) was found, with an ovoid isoechoic nodule being the most frequent US presentation. When AFTNs were reclassified according to US RSSs, the most common categories were low and intermediate risk. AFTNs were assessed as being at high risk/high suspicion/malignant in 1%‐9%, with good agreement among AACE/ACE/AME, ATA, EU‐TIRADS, K‐TIRADS and TIRADS. Remarkably, FNA was indicated in 27%‐90% of AFTNs. A statistically significant difference among the systems was found; 8% of cases were nonclassifiable by one or more US RSS. Conclusions Ultrasound RSSs prompt inappropriate FNA in a significant number of patients with AFTN.

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Is there still a role for thyroid scintigraphy in the workup of a thyroid nodule in the era of fine needle aspiration cytology and molecular testing?

Cited by 18 publications

References 56 publications

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

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