Prediction of thyroid nodule histopathology by expert ultrasound evaluation

Abstract

Objective: The basis of thyroid nodule diagnostics is ultrasound guided fine needle biopsy with cytological evaluation (FNC), if US appearance is not clearly benign. The aim of this study was to investigate the predictive potential of dedicated, expert high resolution ultrasound, to see if histopathological entities of thyroid nodules can be diagnosed without invasive FNC biopsies. Design: Prospective case cohort study. Methods: 180 patients with 221 thyroid nodules were examined with ultrasound and prospectively assigned to the expected histopathological diagnosis: colloid nodule, adenomatoid colloid nodule, follicular adenoma, follicular carcinoma, follicular variant of papillary thyroid carcinoma, papillary thyroid carcinoma, or other thyroid cancer. In 101 of these, we later obtained histopathological reports for comparison. Results: Overall accuracy for classification into discrete histopathological categories by expert ultrasound was 71.3% and Cohen’s Kappa was 0.62. The sensitivity and specificity for detecting malignancy was 97.3% and 78.1%. The diagnostic accuracy for malignancy was 85.1%. ACR-TIRADS scores for the same nodules had a sensitivity of 97.3%, specificity of 26.6%, and accuracy of 52.5%. Conclusion: Dedicated expert high-resolution ultrasound without FNC can reliably distinguish benign versus malignant nodules, but also differentiate between several histopathological entities in thyroid nodules. There is potential for a reduction in the number of invasive FNC biopsies and diagnostic operations.

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

“…Most existing studies evaluating ACR-TIRADS in adulthood have determined that the system score is useful for managing thyroid nodules and reducing the number of unnecessary FNAB, while some concerns remain about its reliability in evaluating nodules of indeterminate cytology (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Among the different TIRADS, ACR-TIRADS was ranked as the best performing classification for identifying high-risk nodules and unnecessary FNABs (35, 36, 52-60), although a missed malignancy diagnosis occurred in 10.2-20% of cases in which ACR-TIRADS have not indicated the need for FNAB (46,55,61).…”

“…Most existing studies evaluating ACR-TIRADS in adulthood have established that the score is useful for managing thyroid nodules and reducing the number of unnecessary FNAB procedures, while there are some concerns about its reliability for the evaluation of nodules with indeterminate cytology (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Among the different TIRADS classification systems, ACR-TIRADS has been indicated as the most accurate classification system for identifying high-risk nodules and preventing most unnecessary FNABs (35, 36, 52-60), although in 10.2-96 20% of cases a failure to diagnose malignancy has been reported (46,55,61).…”

Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines

“…In addition, some of our findings suggested that DTC in the Philippines is more advanced at presentation: ultrasound showed more solid nodules, micro-calcifications, larger tumors, and multi-nodular disease than observed in Qatar, features that suggest thryoid cancer risk or development of multiple recurrences [ 8 , 41 ]; patients presented with higher tumor burden (less stage I, more stage IV disease) [ 11 , 22 ]; and TNM classification showed that 4.7% of patients in the Philippines had distant metastasis (M1) [ 11 ] vs 0% in Qatar. Collectively, the above clinical, ultrasound and histopathology findings suggested that DTC among Filipinos in Qatar appears to behave in a quite dissimilar manner compared to that in the Philippines.…”