Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification

Lam, Cesar; McGettigan, Melissa; Thompson, Zachary; Khazai, Laila; Chung, Christine H.; Centeno, Barbara A.; McIver, Bryan; Valderrábano, Pablo

doi:10.1007/s12020-019-02000-0

Cited by 16 publications

(24 citation statements)

References 29 publications

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“…According to the meta-analysis conducted by Bychkov et al (25 studies,46,948 patients with PTC), the prevalence of NIFTP is 9.1% (95% CI, 6.0-12.7%) of all PTC cases; the rate of NIFTP is considerably lower in the Asian population (1.6%, 95% CI, 0.9-2.5%) than in Western Europe and America (13.3%, 95% CI, 9.0-18.3%) (22). The observed difference in NIFTP prevalence between Asian and non-Asian countries can be attributed to ethnic variance (different mutation profiles of thyroid cancer) (23), differences in the interpretation of histological criteria (24) and differences in clinical practice (lower resection rates in patients with indeterminate thyroid cytologies) (25).…”

Section: Epidemiologymentioning

confidence: 99%

“…On ultrasound (US) examination, NIFTP is usually a well-circumscribed, oval-to-round nodule with regular margins and variable echogenicity, ranging from markedly hypoechoic to hypoechoic, isoechoic and heterogeneous (27,41,43,44,45). Such significant differences in the reported echogenicity of NIFTPs are not surprising because echogenicity is considered to be the feature with the lowest inter-observer agreement (46,47,48). The presence of calcifications is rare (27, 41, 44).…”

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Zajkowska

Kopczyński

Góźdż

et al. 2020

Endocrine Connections

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline thyroid tumour formerly known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma. The prevalence of NIFTP is estimated at 4.4–9.1% of all papillary thyroid carcinomas worldwide; however, the rate of occurrence of NIFTP is eight times lower in Asian countries than in Western Europe and America. At the molecular level, NIFTP is characterised by the lack of BRAF V600E and BRAF V600E-like mutations or other high-risk mutations (TERT, TP53) and a high rate of RAS mutations, which is similar to other follicular-pattern thyroid tumours. The diagnosis of NIFTP can only be made after histological examination of the entire tumour removed during surgery and is based on strictly defined inclusion and exclusion criteria. Although the diagnosis is postoperative, the combination of certain findings of preoperative tests including ultrasonography, cytology, and molecular testing may raise suspicion of NIFTP. These tumours can be effectively treated by lobectomy, although total thyroidectomy remains an option for some patients. Radioactive iodine and thyroid stimulating hormone suppression therapy are not required. NIFTP has an extremely good prognosis, even when treated conservatively with lobectomy alone. Nevertheless, it cannot be considered as a benign lesion. The risk of adverse outcomes, including lymph node and distant metastases, is low but not negligible.

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Section: Epidemiologymentioning

confidence: 99%

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Zajkowska

Kopczyński

Góźdż

et al. 2020

Endocrine Connections

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“…Thus, objective US findings need to be critically processed by the operator, who can re-weight the risk with respect to what is established by the classification system alone. Thus, in the clinical daily life thyroid US remains a subjective imaging tool that holds the operator expertise as an intrinsic characteristic of this instrument (24,25). From a practical point of view, nodules considered as suspect or very suspect (MUT class 4 or 5) by the US operator need to undergo FNA, since the malignancy risk is of 63 and 90%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Specifications of each of the five categories were defined according to the knowledge present in the literature, leaving the US operator the possibility to rule on the nodule category risk based on his ultrasound-clinical experience. Starting from the concept that there is inter-observer and intra-observer variability in interpreting US characteristics and that available US classifications do not cover all US characteristics (24,25), the operator was asked to downgrade or upgrade the class of risk in presence of its judgment based also on clinical (not US) data available and on his advisory opinion arising from his/her US series of experience.…”

Section: Us Classificationsmentioning

confidence: 99%

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The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

et al. 2020

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Objective: Several ultrasound classifications for thyroid nodules were proposed but their accuracy is still debated, since mainly estimated on cytology and not on histology. The aim of this study was to test the diagnostic accuracy and the inter-classification agreement of AACE/ACE-AME, American Thyroid Association (ATA), British Thyroid Association (BTA), and Modena Ultrasound Thyroid Classification (MUT) that stratifies malignancy risk considering also the clinician subjective impression. Methods: A prospective study collecting thyroid nodule features at ultrasound and histological diagnosis was conducted. Ultrasound features were collected following a preformed checklist in candidates for surgery because of indeterminate, suspicious, or malignant cytology. All the nodules, besides the cytologically suspicious one, were blinded analyzed. MUT score was applied prospectively, and the others retrospectively. Sensitivity, specificity, diagnostic cutoff value, and accuracy of each classification were calculated. The overall agreement between classifications was tested by Bland-Altman, and agreement between single nodule analysis by different classifications by Weighted Cohen's Kappa. Results: In classifying a total of 457 nodules, MUT has the highest accuracy (AUC 0.808) and specificity (89%), followed by ATA and BTA, and finally by AACE/ACE-AME. ATA, BTA, and MUT are highly interchangeable. Considering agreement between single nodule analyses, ATA and BTA had the best (κ = 0.723); AACE/ACE-AME showed slight agreement with BTA (κ = 0.177) and MUT (κ = 0.183), and fair agreement with ATA (κ = 0.282); MUT had fair agreement with both ATA (κ = 0.291) and BTA (κ = 0.271). Conclusion: Classifications have an acceptable overall diagnostic accuracy, improved using a less rigid system that takes into consideration operator subjective impression.

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Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow‐up: Current status and future trends

Boers

Braak

Rikken

et al. 2023

J of Clinical Ultrasound

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Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter-and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.

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Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification

Cited by 16 publications

References 29 publications

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow‐up: Current status and future trends

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