Reliability of Thyroid Imaging Reporting and Data System (TI-RADS), and ultrasonographic classification of the American Thyroid Association (ATA) in differentiating benign from malignant thyroid nodules

Macedo, Bruno Mussoi de; Izquierdo, Rogério Friedrich; Golbert, Lenara; Meyer, Erika L. Souza

doi:10.20945/2359-3997000000018

Cited by 18 publications

(20 citation statements)

References 34 publications

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“…The main limit of guidelines proposed by international societies derives from the lack of specificity, mostly at highest categories. In fact, we confirm that they all have high sensitivity but low specificity ( 18 , 21 , 28 ). Accordingly, malignancy rate remains between 41 and 50% even in the highest risk class, with possible consequent over-medicalization and unnecessary FNA.…”

Section: Discussionsupporting

confidence: 74%

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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Section: Discussionsupporting

confidence: 74%

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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“…The risk of cancer in TI-RADS 2 is reported to be 0%, and the risk of cancer in TI-RADS 3 is reported to be 2-4%. In other studies, the expected malignancy rate in TI-RADS 3 was 0.7% [16,17] [9,13,18] In our study, malignancy was 0% in post-operative pathology reports in TI-RADS 2-3 cases. The risk of cancer was reported to be 6-17% in patients with a TI-RADS score of 4 [8].…”

Section: Discussionsupporting

confidence: 56%

Use of the TI-RADS scoring system in the evaluation of thyroid nodules

Gökosmanoğlu¹

2019

Ann Clin Anal Med

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Aim: Thyroid ultrasonography-guided fine needle aspiration is known to be a cost-effective, safe diagnostic method for evaluating thyroid nodules but it is an invasive procedure. Various sonographic criteria have been proposed to estimate the risk of malignancy in thyroid nodules. TI-RADS (Thyroid Image Reporting and Data System) is one of these scoring systems. In this study, it was aimed to investigate the reliability and applicability of the TI-RADS system in our operated patients with definite TI-RADS results. Material and Method: A total of 134 patients who underwent surgery for nodular or multinodular goiter diagnosis between September 2005 and June 2018 in the Medical Park Hospital and Fatsa State Hospital endocrinology clinic and general surgery clinic were included in the study. Demographic characteristics, preoperative thyroid ultrasonographic findings and postoperative pathology results were collected retrospectively. Results: In our study, we found the rate of thyroid cancer as 0% in cases with TI-RADS score 2-3, the rate of cancer as 61.5% (12 papillary thyroid cancer and 4 follicular thyroid cancer in total 16 thyroid cancer n: 16) in cases with TI-RADS score 4 and the rate of cancer 88.2% (papillary thyroid cancer n: 24, medullary thyroid cancer n: 2, follicular thyroid cancer n: 2, indeterminate thyroid cancer n: 2) in cases with TI-RADS score 5. Discussion: Many studies have shown that this thyroid ultrasonography function is not only a risk classification, but also an effective treatment for patients. In our study, we clearly demonstrated that the use of the TI-RADS scoring system in thyroid nodules assessed by experienced individuals prevented the need for unnecessary fine needle aspiration. These findings show that TI-RADS classification provides reliable results in well-categorized thyroid nodules.

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“…Although there have been a few studies that have compared different risk stratification systems [21][22][23][24], and in particular, the ATA and ACR-TIRADS systems [25,26], to our knowledge, this is the first study to evaluate the performance of these two systems using raters from multiple clinical disciplines. We found that both ATA and ACR TI-RADS risk stratifications systems exhibited similar diagnostic performance and interobserver agreement, although ATA guidelines were more accurate in predicting the malignancy risk for each risk stratum in our study population.…”

Section: Discussionmentioning

confidence: 99%

A Multidisciplinary Head-to-Head Comparison of American College of Radiology Thyroid Imaging and Reporting Data System and American Thyroid Association Ultrasound Risk Stratification Systems

et al. 2019

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Background. Ultrasound plays a critical role in evaluating thyroid nodules. We compared the performance of the two most popular ultrasound malignancy risk stratification systems, the 2015 American Thyroid Association (ATA) guidelines and the American College of Radiology Thyroid Imaging and Reporting Data System (ACR TI-RADS). Materials and Methods. We retrospectively identified 250 thyroid nodules that were surgically removed from 137 patients. Their ultrasound images were independently rated using both ATA and ACR TI-RADS by six raters with expertise in ultrasound interpretation. For each system, we generated a receiver operating characteristic curve and calculated the area under the curve (AUC). Results. Sixty-five (26%) nodules were malignant. There was "fair agreement" among raters for both ATA and ACR TI-RADS. Our observed malignancy risks for ATA and ACR TI-RADS categories were similar to expected risk thresholds with a few notable exceptions including the intermediate ATA risk category and the three highest risk categories for ACR TI-RADS. Biopsy of 226 of the 250 nodules would be indicated by ATA guidelines based on nodule size and mean ATA rating. One hundred fortysix nodules would be biopsied based on ACR TI-RADS. The sensitivity, specificity, and negative and positive predictive values were 92%, 10%, 79%, and 27%, respectively, for ATA and 74%, 47%, 84%, and 33%, respectively, for ACR TI-RADS. The AUC for ATA was 0.734 and for ACR TI-RADS was 0.718. Conclusion. Although both systems demonstrated good diagnostic performance, ATA guidelines resulted in a greater number of thyroid biopsies and exhibited more consistent malignancy risk prediction for higher risk categories. The Oncologist 2020;25:398-403 Implications for Practice: With the rising incidence of thyroid nodules, the need for accurate detection of malignancy is important to avoid the overtreatment of benign nodules. Ultrasonography is one of the key tools for the evaluation of thyroid nodules, although the use of many different ultrasound risk stratification systems is a hindrance to clinical collaboration in everyday practice and the comparison of data in research. The first step toward the development of a universal thyroid nodule ultrasound malignancy risk stratification system is to better understand the strengths and weaknesses of the current systems in use.

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Reliability of Thyroid Imaging Reporting and Data System (TI-RADS), and ultrasonographic classification of the American Thyroid Association (ATA) in differentiating benign from malignant thyroid nodules

Abstract: Both TI-RADS and the ATA guidelines have high sensitivity and NPV for the diagnosis of thyroid carcinoma. These systems are feasible for clinical application, allowing to better select patients to undergo fine-needle aspiration biopsies.

Cited by 18 publications

References 34 publications

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

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

Use of the TI-RADS scoring system in the evaluation of thyroid nodules

A Multidisciplinary Head-to-Head Comparison of American College of Radiology Thyroid Imaging and Reporting Data System and American Thyroid Association Ultrasound Risk Stratification Systems

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