Overview of the Ultrasound Classification Systems in the Field of Thyroid Cytology

Rossi, Esther Diana; Pantanowitz, Liron; Raffaelli, Marco; Fadda, Guido

doi:10.3390/cancers13133133

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…At each step of the management of nodules, combining TIRADS evaluation with FNAC result may greatly favour the right therapeutic choices and diminish unnecessary thyroid procedures (2,19). However, to our knowledge, limited literature exists on the evaluation of the inter-observer variability of the cytological diagnosis of thyroid nodules according to the three main classification systems (i.e., Bethesda, RCPath, ICCRTC) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”

Section: Introductionmentioning

confidence: 99%

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Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS

et al. 2022

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Our institution (University Hospital "L. Vanvitelli" -Naples, Italy) is a highvolume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital "L. Vanvitelli" from January 2016 to December 2021 were retrospectively reviewed. Fleiss' kappa (k) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (k=0.133).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS

et al. 2022

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“…Various TIRADS have their own advantages. For example, the EU-TIRADS and ATA guidelines are pattern-dependent systems characterized by a high negative predictive value and sensitivity, whereas the ACR-TIRADS is a typical score-based system with a high positive predictive value and specificity [9][10][11]. We assume that various TIRADS will probably form complementary relationships based on these facts.…”

Section: Introductionmentioning

confidence: 99%

A new discriminant strategy combined with four TIRADS screening procedures increases ultrasound diagnostic accuracy—focusing on “wrong diagnostic” thyroid nodules

Wang

Lai

et al. 2022

Eur Radiol

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Objective To utilize the discrepancies of different TIRADS, including ACR-TIRADS, Kwak-TIRADS, C-TIRADS, and EU-TIRADS, to explore methods for improving ultrasound diagnostic accuracy. Methods In total, 795 nodules with cytological or surgical pathology were included. All nodules were screened by the four TIRADS according to their diagnostic concordance (Screening procedures, SP). Discriminant strategy (DS) derived from predictor variables was combined with SP to construct the evaluation method (SP+DS). The diagnostic performance of the SP+DS method alone and its derivational methods and two-TIRADS combined tests was evaluated. Results A total of 86.8% (269/310) malignant nodules and 93.6% (365/390) benign cases diagnosed by the four TIRADS simultaneously were pathologically confirmed, while 12.0% (95/795) nodules could not be consistently diagnosed by them. The criteria of DS were that iso- or hyper-echogenicity nodules should be considered benign, while hypo- or marked hypo-echogenicity nodules malignant. For 95 inconsistently diagnosed nodules screened by at least two TIRADS, DS performed best with an accuracy of 79.0%, followed by Kwak-TIRADS (72.6%). In the overall sample, the sensitivity and AUC were highest for the SP+DS method compared to the four TIRADS (91.3%, 0.895). Combining ACR-TIRADS and Kwak-TIRADS via parallel test resulted in significant improvements in the sensitivity and AUC compared to ACR-TIRADS (89.2% vs. 81.4%, 0.889 vs. 0.863). Combining C-TIRADS and DS in serial resulted in the highest AUC (0.887), followed by Kwak-TIRADS (0.884), while EU-TIRADS was the lowest (0.879). Conclusions For undetermined or suspected thyroid nodules, two-TIRADS combined tests can be used to improve diagnostic accuracy. Otherwise, considering the inconsistent diagnosis of two TIRADS may require attention to the echo characteristics to differentiate between benign and malignant nodules. Key Points • The discrepancies in the diagnostic performance of different TIRADS arise from their performance on inconsistently diagnosed nodules. • ACR-TIRADS improves sensitivity via combining with Kwak-TIRADS in parallel (from 81.4 to 89.2%), while C-TIRADS increases specificity via combining with EU-TIRADS in serial (from 80.9 to 85.7%). • If the diagnostic findings of two TIRADS are inconsistent, echo characteristics will be helpful for the differentiation of benign and malignant nodules with an accuracy of 79.0%.

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“…Thyroid lesions are divided into five categories based on the comparison of echogenicity between the cervical strap muscle and thyroid: anechoic, markedly hypoechoic (echogenicity lower than that of the cervical strap muscle), hypoechoic (echogenicity between that of the cervical strap muscle and thyroid parenchyma), isoechoic (with the same echogenicity as the thyroid parenchyma), and hyperechoic (more echoic than the thyroid parenchyma) [ 1 – 3 ]. The diagnostic values of the hypoechoic and markedly hypoechoic categories have been widely accepted for thyroid malignant nodules [ 1 , 4 – 7 ]. However, distinguishing between hypoechoic and markedly hypoechoic categories is a subjective process that is influenced by the observer’s judgment.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound grayscale ratio: a reliable parameter for differentiating between papillary thyroid microcarcinoma and micronodular goiter

Gong

Yao

et al. 2022

BMC Endocr Disord

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Background The present study aimed to quantify and differentiate the echo levels of papillary thyroid microcarcinomas (PTMCs) and micronodular goiters (MNGs) using the ultrasound grayscale ratio (UGSR) and to investigate the repeatability of UGSR. Methods The ultrasound (US) data of 241 patients with 265 PTMCs and 141 patients with 168 MNGs confirmed by surgery and pathology were retrospectively analyzed. All patients had received outpatient ultrasonic examination and preoperative ultrasonic positioning. The RADinfo radiograph reading system was used to measure the grayscales of PTMC, MNG, and thyroid tissues at the same gain level, and the UGSR values of the PTMC, MNG, and thyroid tissue were calculated. The patients were divided into outpatient examination, preoperative positioning, and mean value groups, and the receiver operating characteristic (ROC) curves were calculated to obtain the optimal UGSR threshold to distinguish PTMC from MNG. The interclass correlation coefficient (ICC) was used to assess the consistency of UGSR measured in three groups. Results The UGSR values of the PTMC and MNG were 0.56 ± 0.14 and 0.80 ± 0.19 (t = 5.84, P < 0.001) in the outpatient examination group, 0.55 ± 0.14 and 0.80 ± 0.19 (t = 18.74, P < 0.001) in the preoperative positioning group, and 0.56 ± 0.12 and 0.80 ± 0.18 (t = 16.49, P < 0.001) in the mean value group. The areas under the ROC curves in the three groups were 0.860, 0.856, and 0.875, respectively. When the UGSR values for the outpatient examination, preoperative positioning, and mean value groups were 0.649, 0.646, and 0.657, respectively, each group obtained its largest Youden index. A reliable UGSR value was obtained between the outpatient examination and preoperative positioning groups (ICC = 0.79, P = 0.68). Conclusion UGSR is a simple and repeatable method to distinguish PTMC from MNG, and hence, can be widely applicable.

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Overview of the Ultrasound Classification Systems in the Field of Thyroid Cytology

Cited by 8 publications

References 46 publications

Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS

Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS

A new discriminant strategy combined with four TIRADS screening procedures increases ultrasound diagnostic accuracy—focusing on “wrong diagnostic” thyroid nodules

Ultrasound grayscale ratio: a reliable parameter for differentiating between papillary thyroid microcarcinoma and micronodular goiter

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