Malignancy risk stratification of thyroid nodules: comparisons of four ultrasound Thyroid Imaging Reporting and Data Systems in surgically resected nodules

Wang, Ying; Lei, Kairong; He, Yaping; Li, Xiaolong; Ren, Weiwei; Zhao, Chong‐Ke; Bo, Xiao-Wan; Wang, Dan; Sun, Chengyu; Xu, Hui‐Xiong

doi:10.1038/s41598-017-11863-0

Cited by 28 publications

(16 citation statements)

References 32 publications

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“…In addition, Yoon et al found that both the TI‐RADS of Kwak et al and the ATA guidelines provided effective malignancy risk stratification for thyroid nodules. In a comparative study of 6 guidelines for small thyroid nodules, Yoon et al found that the sensitivity and NPV were the highest for the TI‐RADS of Kwak et al In a comparative study of 4 TI‐RADSs in surgically resected nodules, Wang et al also found that with its higher sensitivity, the TI‐RADS of Kwak et al was convenient and practical for the management of thyroid nodules in clinical practice. The malignancy rate of each category in this study was consistent with that of Kwak et al, suggesting the universe applicability of this TI‐RADS for the Eastern Asian population.…”

Section: Discussionmentioning

confidence: 99%

Three‐Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules

Zhao

Chen

Alizad

et al. 2018

J of Ultrasound Medicine

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Section: Discussionmentioning

confidence: 99%

Three‐Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules

Zhao

Chen

Alizad

et al. 2018

J of Ultrasound Medicine

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“…proposed by Kwak et al (Kwak TIRADS) has been proven to be practical and easily applicable in the assessment of thyroid nodules 8,[13][14][15][16][17][18][19][20] , and can be performed by simply counting the number of suspicious US features without considering the malignancy probability of each US feature. One recent study compared the diagnostic efficiency of Kwak and ACR TIRADS and found the former to have higher AUC and accuracy 19 .…”

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confidence: 99%

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

Huh

Lee

Yoon

et al. 2020

Sci Rep

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We compared the diagnostic performances and unnecessary fnA rates of several guidelines and modified versions using the size threshold of the ACR TIRADS. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent and all methods were performed in accordance with the Declaration of Helsinki. A total of 1,384 thyroid nodules in 1,301 patients with definitive cytopathologic findings were included. US categories were assigned according to each guideline. We applied the size threshold suggested by the ACR TIRADS for FNA to the Kwak, ATA and EU guidelines and defined these modified guidelines as the modified Kwak (mKwak), modified ATA (mATA) and modified EU (mEU) guidelines. Diagnostic performances and unnecessary FNA rates of all guidelines were evaluated. Of 1,384 thyroid nodules, 291 (21%) were malignant. Among the original guidelines, the ACR TIRADS had the highest specificity, accuracy, LR and AUC (62.2%, 66%, 2.128 and 0.713). The mKwak, mATA and mEU guidelines had higher specificity, accuracy, LR and AUC (P < 0.001 for all), and fewer unnecessary FNAs, compared with their original guidelines. Among all original and modified guidelines, the mKwak guideline had the highest specificity, accuracy, LR and AUC (64%, 68.6%, 2.389 and 0.75). The unnecessary FNA rate was the lowest with the mKwak guideline (61.1%). The highest sensitivity was observed with the ATA guideline (98.6%). After incorporating the size threshold of the ACR TIRADS to other TIRADS, all guidelines showed higher diagnostic accuracy and lower unnecessary FNA rates than their original versions. The mKwak guideline showed the best diagnostic performances. Thyroid ultrasonography (US) is now regularly performed in clinical practice and thyroid nodules are exceedingly common on US with as many as 68% of adults having one, leading to issues of overdiagnosis and overtreatment 1,2. Many guidelines recommend fine-needle aspiration (FNA) based on several risk stratification systems which use different US features and even different size thresholds 3-7. Current risk stratification systems using US features can be broadly divided into two types: the point-scale Thyroid Imaging Reporting and Data System (TIRADS) suggested by Kwak et al. 8 , Park et al. 9 and the American College of Radiology (ACR) 3 and the pattern-recognition TIRADS suggested by Horvath et al. 10 , the 2015 American Thyroid Association (ATA) 7 , and European Thyroid Association (EU) 11. Different size criteria have been suggested by the ATA guideline, ACR and EU TIRADS 3,7,11. Although there are many guidelines for recommending FNA for thyroid nodules on US, a worldwide communicable system does not presently exist. Recently, Grani et al. 12 demonstrated that the ACR TIRADS reduced unnecessary FNAs more than other international guidelines with a very low false-negative rate (2.2%, 6/268). The ACR TIRADS suggests a higher size threshold for FNA than other guidelines while still recommending similar malignancy risks for each final assessment ca...

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“…A patient's nodule is classified by comparing it with this set of standard nodules. This process is difficult to integrate into clinical routine and does not cover all types of thyroid nodules (14,15). More recently, several further TIRADS versions were introduced, including the Korean-TIRADS (16)(17)(18), based on the modified publication by Kwak et al in 2011 and 2013 (19,20).…”

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confidence: 99%

“…Basically, in the Kwak-TIRADS a sum score for each thyroid nodule according to 5 defined sonographic nodule features is calculated to determine the need for fine-needle biopsy. This simple scoring system is more applicable to the classification of thyroid nodules in a clinical setting (14,15,18). The American College of Radiology presented a more sophisticated TIRADS in 2015 (21,22), and the EU-TIRADS by the European Thyroid Association followed in 2017 (23).…”

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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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Malignancy risk stratification of thyroid nodules: comparisons of four ultrasound Thyroid Imaging Reporting and Data Systems in surgically resected nodules

Cited by 28 publications

References 32 publications

Three‐Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules

Three‐Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules

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

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

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