Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study.
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SUBMITTER: Leni D
PROVIDER: S-EPMC8124822 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Due to the widespread use of ultrasound, small thyroid nodules (TNs) ? 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ? 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.
| S-EPMC7019412 | biostudies-literature
Project description:PurposeTo explore the characteristics of C-TIRADS by comparing it with ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS and EU-TIRADS.MethodsA total of 1096 nodules were collected from 884 patients undergoing thyroidectomy in our center between May 2018 and December 2020. Divided the nodules into two groups: ">10mm" and "≤10mm". Ultrasound characteristics of each nodule were observed and recorded by 2 doctors, then classified based on ACR-TIRADS, Kwak-TIRADS, KSThR-TIRADS, EU-TIRADS, and C-TIRADS.ResultsA total of 682 benign nodules cases (62.23%) and 414 malignant nodules cases (37.77%) were identified. The ICC value of each guideline was:0.937(ACR-TIRADS), 0.858(EU-IRADS), 0.811(Kwak-TIRADS), 0.835(KTA/KSThR-TIRADS) and 0.854(C-TIRADS). The nodule malignancy rates in the groups(Kwak-TIRADS 4B, C-TIRADS 4B、4C) of two sizes were significantly different (all p<0.05). There was no statistical difference in the other grades of two sizes (all p>0.05). Unnecessary biopsy rates were the lowest in C-TIRADS (49.02% p<0.001). Furthermore, Kwak-TIRADS had the highest sensitivity and NPV (89.9%, 91.0%, all p<0.05), while C-TIRADS had the highest specificity and PPV (82.3%, 69.2%, all p<0.05). C-TIRADS and Kwak-TIRADS had the highest accuracy (76.0%, 72.5%, P=0.071). The AUCs of the 5 guidelines were C-TIRADS(0.816, P<0.05), Kwak-TIRADS(0.789, P<0.05) KTA/KSThR-TIRADS and ACR-TIRADS(0.773, 0.763, P=0.305), EU-TIRADS(0.734, P<0.05). The AUCs of the five guidelines were not statistically different between "nodules>10mm" and "nodules ≤ 10mm" (all P>0.05).ConclusionsAll five guides showed excellent interobserver agreement. C-TIRADS was slightly efficient than Kwak-IRADS, KTA/KSThR-TIRADS and ACR-TIRADS, and had greater advantages than EU-TIRADS. The diagnostic abilities of the five guidelines for "nodules ≤ 10mm" were not inferior to that of "nodules> 10mm". C-TIRADS is simple and easy to implement and can provide effective thyroid tumor risk stratification for thyroid nodule diagnosis, especially in China.
| S-EPMC8578891 | biostudies-literature
Project description:Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1-5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.
| S-EPMC7464710 | biostudies-literature
Project description:The aim was to compare the usefulness of selected thyroid sonographic risk-stratification systems in the diagnostics of nodules with indeterminate/suspicious cytology or unequivocal cytology in a population with a history of iodine deficiency. The diagnostic efficacy of ACR-TIRADS (the American College of Radiology Thyroid Imaging Reporting and Data Systems), EU-TIRADS (European Thyroid Association TIRADS), Korean-TIRADS, Kwak-TIRADS, AACE/ACE-AME-guidelines (American Association of Clinical Endocrinologists/ American College of Endocrinology-Associazione Medici Endocrinologi guidelines) and ATA-guidelines (American Thyroid Association guidelines) was evaluated in 1000 nodules with determined histopathological diagnosis: 329 FLUS/AUS (10.6% cancers), 167 SFN/SHT (11.6% cancers), 44 SM (77.3% cancers), 298 BL (benign lesions), 162 MN (malignant neoplasms). The percentage of PTC (papillary thyroid carcinoma) among cancers was higher in Bethesda MN (86.4%) and SM (suspicion of malignancy) nodules (91.2%) than in FLUS/AUS (57.1%, p < 0.005) and SFN/SHT (suspicion of follicular neoplasm/ suspicion of Hürthle cell tumor) nodules (36.8%, p < 0.001). TIRADS efficacy was higher for MN (AUC: 0.827-0.874) and SM nodules (AUC: 0.775-0.851) than for FLUS/AUS (AUC: 0.655-0.701) or SFN/SHT nodules (AUC: 0.593-0.621). FLUS/AUS (follicular lesion of undetermined significance/ atypia of undetermined significance) nodules assigned to a high risk TIRADS category had malignancy risk of 25%. In the SFN/SHT subgroup none TIRADS category changed nodule's malignancy risk. EU-TIRADS and AACE/ACE-AME-guidelines would allow diagnosing the highest number of PTC, FTC (follicular thyroid carcinoma), HTC (Hürthle cell carcinoma), MTC (medullary thyroid carcinoma). The highest OR value was for Kwak-TIRADS (12.6) and Korean-TIRADS (12.0). Conclusions: TIRADS efficacy depends on the incidence of PTC among cancers. All evaluated TIRADS facilitate the selection of FLUS/AUS nodules for the surgical treatment but these systems are not efficient in the management of SFN/SHT nodules.
| S-EPMC7408998 | biostudies-literature
Project description:BackgroundThe malignancy risks of various echogenic foci in thyroid nodules are not consistent. The association between malignancy and echogenic foci and various Thyroid Imaging Reporting and Data System (TIRADS) in thyroid nodules has not been evaluated. We evaluated the malignancy probability and diagnostic performance of thyroid nodules with various echogenic foci and in combination with TIRADS.MethodsThis retrospective study was approved by Institutional Review Board. The data were retrospectively collected from January 2013 to December 2014. In total, 954 patients (mean age, 50.8 years; range, 13-86 years) with 1112 nodules were included. Using χ2 test, we determined the prevalence of benign and malignant nodules among those with and without echogenic foci; we associated each of 6 echogenic foci types with benign and malignant nodules. Diagnostic performance was compared between the 6 types alone and in combination with various TIRADS.ResultsAmong 1112 nodules, 390 nodules (35.1%) were found to have echogenic foci, and 722 nodules (64.9%) were not. Among nodules with echogenic foci, 254 nodules (65.1%) were malignant. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Our study demonstrated relatively low PPV (33.3-56.4%) in nodules with large echogenic foci without shadowing, macrocalcification, and peripheral curvilinear or eggshell echogenic foci with or without shadowing. However, when combined with high suspicion category of TIRADS, PPV increased to 50.0-90.9%.ConclusionCombination with TIRADS with different types of echogenic foci offer better stratification of the malignancy risk.
| S-EPMC6449957 | biostudies-literature
Project description:Background:To explore the correlation between the ultrasound elasticity score (ES) of real-time tissue elastography (RTE) and the malignant risk stratification of the Thyroid Imaging Reporting and Data System (TI-RADS) and to evaluate the added value of RTE to TI-RADS in differentiating malignant nodules from benign ones. Methods:A total of 1,498 patients (885 women and 613 men; mean age of 43.5?±?12.4 years) with 1,525 confirmed thyroid nodules (D?=?maximum diameter, D???2.5?cm) confirmed by fine-needle aspiration (FNA) and/or surgery were included. The nodules were divided into four groups based on their sizes (D???0.5?cm, 0.5?<?D???1.0?cm, 1.0?<?D???2.0?cm, and 2.0?<?D???2.5?cm). We assigned an ES of RTE and malignant risk stratification of the TI-RADS category to each nodule. The correlation between the ES of RTE and the malignant risk stratification of TI-RADS category was analyzed by the Spearman's rank correlation. The diagnostic performances of RTE, TI-RADS, and their combination were compared by the receiver operator characteristic (ROC) analysis. Results:The ES of RTE and the malignant risk stratification of TI-RADS showed a strong correlation in the size intervals of 0.5?<?D???1.0?cm, 1.0?<?D???2.0?cm, and 2.0?<?D???2.5?cm (r?=?0.768, 0.711, and 0.743, respectively). The diagnostic performance of their combination for each size interval was always better than RTE or TI-RADS alone (for all, P < 0.001). Conclusions:Overall, The ES of RTE was strongly correlated with the malignant risk stratification of TI-RADS. The diagnostic performance of the combination of RTE and TI-RADS outperformed RTE or TI-RADS alone. Therefore, RTE may be an adjunctive tool to the current TI-RADS system for differentiating malignant from benign thyroid nodules.
| S-EPMC7178472 | biostudies-literature
Project description:Background The sonography-based risk stratification of thyroid nodules is based on the different sonographic features of benign and malignant thyroid nodules. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) and the Chinese-TIRADS define different risks for malignancy categories and the size criteria for fine-needle aspiration (FNA). Few studies have compared their diagnostic performance and FNA management approaches. Thus, we sought to compare the diagnostic performance and FNA management approaches of the ACR-TIRADS and Chinese-TIRADS based on surgical histological evidence. Methods This retrospective study included patients with complete thyroid ultrasound images and histologic evidence who were consecutively selected from The Affiliated Hospital of Nanjing University of Chinese Medicine. A total of 333 nodules from 252 patients with definitive surgical histological findings were examined. Ultrasonography categories and FNA management proposals were assigned according to the ACR-TIRADS and Chinese-TIRADS. The thyroid nodules were divided into 2 groups based on a cut-off size of 1 cm. The diagnostic performance and recommended and unnecessary FNA rates for each group were compared for both systems. Results Overall, 280 malignant thyroid nodules (84.1%) and 53 benign nodules (15.9%) were analyzed. Across all groups, the ACR-TIRADS had higher sensitivity, specificity, positive and negative predictive values, and accuracy, and a higher area under the curve (AUC) than the Chinese-TIRADS. However, there was a significant difference in the negative predictive value between the ACR-TIRADS and Chinese-TIRADS of <1 and ≥1 cm, and the overall AUCs differed significantly (39.5% vs. 35.1%, P=0.007 for <1 cm; 70.0% vs. 62.8%, P=0.014 for ≥1 cm; 0.843 vs. 0.806, P=0.037 for all). The rate for recommending the FNA of the nodules in the ACR-TIRADS was lower than that in the Chinese-TIRADS (25.2% vs. 56.5%, P<0.0001), but there was no significant difference between the ACR-TIRADS and Chinese-TIRADS in terms of the unnecessary FNA rate (14.3% vs. 13.8%, P=0.931). The kappa statistics for the consistency of the ACR-TIRADS and Chinese-TIRADS FNA recommendations for nodules sized ≥1.0 to <1.5, ≥1.5 to <2.5, and ≥2.5 cm were 0.084, 0.635, and 0.909, respectively. Conclusions The ACR-TIRADS had slightly better diagnostic performance and a lower recommended FNA rate than the Chinese-TIRADS for thyroid nodules. For thyroid nodules ≥1.5 cm in size, the FNA recommendations of the 2 guidelines had good consistency.
| S-EPMC10006137 | biostudies-literature
Project description:Background The incidence of thyroid lumps is more and more high in population, and most biopsies of thyroid nodules are benign. To develop a practical risk stratification system based on five ultrasound features to stratify the malignancy risk of thyroid neoplasms. Methods This retrospective investigation enrolled 999 consecutive patients with 1,236 thyroid nodules who underwent ultrasound screening. Fine-needle aspiration and/or surgery was performed, and pathology results were obtained at the Seventh Affiliated Hospital of Sun Yat-sen University in Shenzhen, China, which is a tertiary referral center, from May 2018 to February 2022. Each thyroid nodule’s score was calculated based on five ultrasound features: composition, echogenicity, shape, margin, and echogenic foci. Additionally, each nodule’s malignancy rate was calculated. The chi-square test was used to test whether the malignancy rate was different among the three subcategories (scores of 4–6, 7–8, and 9 or more) of thyroid nodules. We proposed the revised Thyroid Imaging Reporting and Data System (R-TIRADS), and its sensitivity and specificity were compared to the two existing systems [the American College of Radiology TIRADS (ACR TIRADS) and the Korean Society of Thyroid Radiology TIRADS (K-TIRADS)]. Results The final dataset consisted of 425 nodules from 370 patients. The malignancy rates of three subcategories [malignancy rate: 28.8% (scores from 4–6), 64.7% (scores from 7–8), and 84.2% (scores of 9 or more)] were significantly different (P<0.01). The unnecessary biopsy rates of the three systems (ACR TIRADS, R-TIRADS, and K-TIRADS) were 28.7%, 25.2%, and 14.8%, respectively. The R-TIRADS presented better diagnostic performance than the ACR TIRADS or K-TIRADS [area under the curve: 0.79 (95% CI: 0.74–0.83) vs. 0.69 (95% CI: 0.64–0.75), P=0.046; 0.79 (95% CI: 0.74–0.83) vs. 0.66 (95% CI: 0.60–0.71), P=0.041, respectively]. The R-TIRADS had the highest sensitivity [0.746 (95% CI: 0.689–0.803)], followed by the K-TIRADS [0.399 (95% CI: 0.335–0.463), P=0.000] and ACR TIRADS [0.377 (95% CI: 0.314–0.441), P=0.000]. Conclusions The R-TIRADS enables radiologists to diagnose thyroid nodules efficiently, and the number of unnecessary fine-needle aspirations can be considerably reduced.
| S-EPMC10240023 | biostudies-literature
Project description:Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.
| S-EPMC5652895 | biostudies-literature
Project description:Simple Summary Thyroid nodules of category III in the Bethesda system do not constitute a uniform group, so it is still a challenge to produce a recommendation for the management of patients with such nodules. The aim of the study was to examine the benefits of the joint use of repeat FNA and a sonographic risk stratification system in category III nodules in relation to the kind of atypia: cytologic/nuclear vs. architectural. Our results indicate that in both kinds of these nodules, the joint evaluation of repeat FNA outcome and sonographic risk of malignancy shows better effectiveness than any of these methods separately. Such a combination allows the identification of patients with a high risk of malignancy as well as a group of patients in which surgical treatment may be safely put aside. Abstract The aim of the study was to examine the benefits of the joint use of repeat FNA (rFNA) and EU-TIRADS in category III nodules in relation to the kind of atypia: nuclear vs. architectural (denoted by AUS and FLUS respectively). The study included 127 AUS and 1739 FLUS nodules with a known category of EU-TIRADS. Repeat FNA was performed in 82 AUS and 934 FLUS nodules of which 57 and 515 were excised, respectively. AUS nodules had higher malignancy risk than FLUS nodules. EU-TIRADS showed higher accuracy for AUS nodules, the opposite to rFNA, that had higher accuracy for FLUS nodules. The combined criterion for AUS nodules (at least rFNA-V or EU-TIRADS-4) maximized sensitivity (92.3%) with acceptable specificity (70.0%); OR: 28.0. In the case of FLUS nodules, the combined criterion (rFNA-V or EU-TIRADS-5) maximized specificity (95.2%) with 57.7% sensitivity and a low percentage (13.9%) of positive nodules, OR: 27.0. In both types of nodules, the low risk category in EU-TIRADS and benign result of rFNA excluded cancer. Concluding, category III nodules with and without nuclear atypia differ in their risk of malignancy and, consequently, diagnostic criteria adopted for the evaluation of these nodules with rFNA and EU-TIRADS should be specific to AUS and FLUS nodules.
| S-EPMC9496843 | biostudies-literature