Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination

Xu, Ting; Wu, Yunong; Wu, Runxin; Zhang, Yuzhi; Gu, Jingyu; Ye, Xinhua; Tang, Wei; Xu, Shuhang; Liu, Chao; Wu, Xiaohong

doi:10.1007/s12020-018-1817-8

Cited by 101 publications

(120 citation statements)

References 42 publications

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“…The efficacy of US classification systems in estimating the risk of malignancy of thyroid nodules and reducing the number of unnecessary thyroid FNA has been evaluated multiple times. Overall, a satisfactory performance was demonstrated for all systems, with some differences . Given that the evidence on suspicious thyroid nodule US features is mainly based on PTC presentation, with sparse data on the less frequent FTC, one would question whether this could be a significant weakness of US RSSs.…”

Section: Discussionmentioning

confidence: 97%

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Castellana

Piccardo

Virili

et al. 2020

Cancer Cytopathology

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BACKGROUND: Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine needle aspirations (FNAs) of thyroid nodules. These systems were designed primarily to identify papillary thyroid carcinomas, thus their performance on follicular thyroid carcinoma (FTC) is debatable. The present study was undertaken to investigate the accuracy of RSSs in selecting FTCs for FNA. METHODS: Patients with FTC who underwent US examinations between 2012 and 2018 in 2 institutions were selected. US images were reviewed retrospectively, and FTCs were reclassified according and Thyroid Imaging Reporting and Data System (TIRADS). Risk class and indication for FNA were assessed. RESULTS:Forty-five FTCs from 45 consecutive patients were included in the study. The median tumor diameter was 32 mm (range, 11-100), and ovoid isoechoic nodule with or without lobulated margins was the most frequent presentation. When FTCs were classified according to RSSs, the most common categories were intermediate and high risk, though 1 case in 3 was not classifiable. FTCs were classified as high risk/high suspicion/malignant in 11% to 74% of cases, with a statistically significant difference among the systems. FNA was indicated in 69% to 100% of cases, with good agreement among AACE/ACE/AME, ACR-TIRADS, and TIRADS. CONCLUSION: Current RSSs show high performance in selecting FTCs for FNA. This result is mainly due to the dimensional RSSs cutoffs indicating FNA. On the contrary, given the reported unsuspicious echo-structural presentation of FTC and the recognized limitation of cytological assessment to detect it, caution is advised when using US to manage cytologically indeterminate nodules. Cancer Cytopathol 2020;128:250-259.

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Section: Discussionmentioning

confidence: 97%

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Castellana

Piccardo

Virili

et al. 2020

Cancer Cytopathology

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“…This is quite consistent with the literature. Xu et al found that 45.4% FNAs were recommended by ETA, revealing 44.5% malignant lesions. Maino et al showed that according to ETA US risk stratification systems, 56% nodules did not meet the criteria for FNA.…”

Section: Discussionmentioning

confidence: 99%

A multicentre validation study for the EU‐TIRADS using histological diagnosis as a gold standard

Trimboli

Ngu

Royer³

et al. 2019

Clinical Endocrinology

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Objective Many systems for risk stratification of thyroid nodule with ultrasound (US) have been proposed and the EU‐TIRADS issued by the ETA in 2017 was the last to have been published. The present study was undertaken to evaluate whether the malignancy risk of each category corresponded to the given range of the guidelines and assess the diagnostic value of EU‐TIRADS in a multi‐institutional trial with histology as gold standard. Design Three institutions in Switzerland, France and United Kingdom shared this retrospective study. Enrolment period was 2013‐2017. Included were patients who had undergone surgery with a detailed preoperative thyroid US. Methods Cancer risk was calculated for each EU‐TIRADS score. Predictivity tests were estimated. Nonparametric statistical analysis was used. Results The final series included 1058 nodules of which 257 (24.3%) carcinomas. Nodules were classified as EU‐TIRADS 2, 3, 4 and 5 in 6.7, 46.4, 26.2 and 20.7%, respectively. Cancer prevalence was 1.4, 3.5, 17 and 87.7% in classes 2‐5, respectively (P < 0.0001). EU‐TIRADS 5 had a significantly higher cancer rate than the other summed categories (7.7%; P < 0.0001) with OR 84.7. When EU‐TIRADS 4 and 5 were combined, 93% sensitivity and 97% NPV were found and findings of the three institutions were quite similar. Using the recommended criteria for FNA negative predictive value was 90.9%. Conclusions The cancer rate was within or close to the given range described in the EU‐TIRADS guidelines. The diagnostic value was satisfactory. The results were similar in the three institutions participating in the study.

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“…Previous ACR-TIRADS validation studies reported similar diagnostic metrics. Xu et al [12] reported 96.6% sensitivity, 52.9% specificity, and an AUC of 0.84 using the ACR-TIRADS to discriminate benign from malignant thyroid nodules. Zheng et al [13] evaluated 1,033 nodules from 1,013 patients and found that the ACR-TIRADS had a high sensitivity reaching 99.0%, despite low specificity (43.4%).…”

Section: Discussionmentioning

confidence: 99%

“…[4] Consistent with previous studies, we successfully categorized all nodules in the present study using the ACR-TIRADS. [10][11][12][13] One of the main theoretical frameworks of these classification systems, including ACR-TIRADS, is to reduce the number of unnecessary biopsies, particularly for benign nodules. Hoang et al [14] evaluated the number of biopsy decisions made by eight radiologists based on their own practice patterns and according to the ACR-TIRADS criteria for 100 thyroid nodules (15 malignant and 85 benign).…”

Section: Discussionmentioning

confidence: 99%

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Single-center validation study of the American College of Radiology Thyroid Imaging Reporting and Data System in a Turkish adult population

Çolakoğlu¹

2019

Tr-ENT

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Objectives: This study aims to evaluate diagnostic performance of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) in the Turkish adult population. Patients and Methods: A total of 422 thyroid nodules of 368 patients (103 males, 265 females; mean age 46.43 years; range, 18 to 81 years) diagnosed by fine needle aspiration biopsy (FNAB) or surgical pathology were retrospectively analyzed. The decisions for FNABs were mostly made by the experts of our hospital without using the ACR-TIRADS. The observers assessed five different aspects of thyroid nodules: echogenicity, shape, composition, margin, and echogenic foci. Nodules with 0 points were categorized as TR1, 2 points as TR2, 3 points as TR3, 4-6 points as TR4, and ≥7 points as TR5. The sensitivity, specificity, and diagnostic accuracy of ACR and the proportion of benign nodules and malignant nodules to be biopsied according to the ACR-TIRADS were calculated. Results: The ACR-TIRADS identified 47 of 54 malignant nodules and identified 264 of 368 benign nodules yielding 73.6% diagnostic accuracy. Using the ACR-TIRADS would have spared 64.1% of benign nodules from FNAB. Of 54 malignant nodules, 23 were to be biopsied, 30 to be followed, and one malignant nodule was not planned to be biopsied or followed according to the ACR-TIRADS recommendations. Conclusion: Despite its robustness in sparing a substantial number of benign nodules from FNAB, the use of ACR-TIRADS would prevent 55.5% of malignant nodules from FNAB. We suggest that FNAB threshold levels of the ACR-TIRADS should be extensively reviewed by the Turkish radiologists, endocrinologists, general surgeons, and ear, nose and throat surgeons before integrating the system to their daily practice.

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Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination

Cited by 101 publications

References 42 publications

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

A multicentre validation study for the EU‐TIRADS using histological diagnosis as a gold standard

Single-center validation study of the American College of Radiology Thyroid Imaging Reporting and Data System in a Turkish adult population

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