Reappraising the role of thyroid scintigraphy in the era of TIRADS: A clinically-oriented viewpoint

Trimboli, Pierpaolo; Bojunga, Joerg; Deandrea, Maurilio; Frasca, Francesco; Imperiale, Alessio; Leoncini, Andrea; Paone, Gaetano; Pitoia, Fabian; Rotondi, Mario; Sadeghi, Ramin; Scappaticcio, Lorenzo; Treglia, Giorgio; Piccardo, Arnoldo

doi:10.1007/s12020-024-03825-0

Cited by 3 publications

(1 citation statement)

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“…Additionally, the following limitations of this study should also be recognized: limited core data available for assessment in the thyroid module of the EUROCRINE register (for example, details on preoperative serum calcitonin levels or thyroid scintigraphy are not reported to the register if the preoperative work-up indicates benign thyroid disease) [ 30 ], the potential for interobserver variability in the application of the EU-TIRADS and FNA cytology across different centers, and variability in expertise between high-volume and low-volume centers, which can influence the reliability and accuracy of the data collected [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The European Thyroid Imaging and Reporting Data System as a Remedy for the Overdiagnosis and Overtreatment of Thyroid Cancer: Results from the EUROCRINE Surgical Registry

Hellmann,

Wiśniewski,

Śledziński

et al. 2024

Cancers

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Background: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. Method: We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low–moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. Results: We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low–moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low–moderate risk, 21% high risk, and only 0.7% minimal risk. Conclusion: The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

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Section: Discussionmentioning

confidence: 99%