Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology

Chng, Chiaw Ling; Kurzawinski, Tom; Beale, Tim

doi:10.1111/cen.12692

Cited by 55 publications

(47 citation statements)

References 30 publications

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“…In particular, dichotomizing the TIR3A and TIR3B categories based on low-risk TI-RADS score (3, 4a, and 4b) and high-risk TI-RADS score (4c and 5), the risk of malignancy for indeterminate lesions could be stratified in three classes: low (below 10%), intermediate (about 20%), and high (about 80%). Similar results were recently reported by Maia and colleagues using the Bethesda system and by Chng and colleagues using the BTA-RCPath system [38, 39]. …”

Section: Discussionsupporting

confidence: 91%

Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

Ulisse

Bosco

Nardi

et al. 2017

International Journal of Endocrinology

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The new Italian cytological classification (2014) of thyroid nodules replaced the TIR3 category of the old classification (2007) with two subclasses, TIR3A and TIR3B, with the aim of reducing the rate of surgery for benign diseases. Moreover, thyroid imaging reporting and data system (TI-RADS) score appears to ameliorate the stratification of the malignancy risk. We evaluated whether the new Italian classification has improved diagnostic accuracy and whether its association with TI-RADS score could improve malignancy prediction. We retrospectively analyzed 70 nodules from 70 patients classified as TIR3 according to the old Italian classification who underwent surgery for histological diagnosis. Of these, 51 were available for cytological revision according to the new Italian cytological classification. Risk of malignancy was determined for TIR3A and TIR3B, TI-RADS score, and their combination. A different rate of malignancy (p = 0.0286) between TIR3A (13.04%) and TIR3B (44.44%) was observed. Also TI-RADS score is significantly (p = 0.003) associated with malignancy. By combining cytology and TI-RADS score, patients could be divided into three groups with low (8.3%), intermediate (21.4%), and high (80%) risk of malignancy. In conclusion, the new Italian cytological classification has an improved diagnostic accuracy. Interestingly, the combination of cytology and TI-RADS score offers a better stratification of the malignancy risk.

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Section: Discussionsupporting

confidence: 91%

Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

Ulisse

Bosco

Nardi

et al. 2017

International Journal of Endocrinology

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“…Park et al [7] found that in the category IV the evaluation of UMRFs had the lowest efficiency in the comparison with other groups of cytological diagnoses (the risk of malignancy in that group was 5.7%). On the other hand, in the group of nodules of the IV diagnostic category and with 24.3% overall malignancy rate Chng et al [1] showed the usefulness of assessing irregular margins, hypoechogenicity, and taller-than-wide shape, despite the fact that the percentage of PTCs among malignant neoplasms was below 50% in that study. However, a noticeable amount (40%) of the patients in that group were not treated surgically.…”

Section: Discussionmentioning

confidence: 78%

“…Also in that study, PTCs constituted nearly 90% of all malignant neoplasms. On the other hand, Chng et al [1] showed the usefulness of TIRADS scores 4C and 5 in predicting malignancy of category IV nodules, but that study had retrospective design and nearly half of the patients did not have histological results.…”

Section: Discussionmentioning

confidence: 99%

“…Among others, the usefulness of classic ultrasonography is evaluated in the selection of nodules for fine-needle aspiration biopsy (FNA) or in assisting clinical decision making in patients with equivocal FNA results – mainly in patients with follicular lesions (FL) [1–10]. …”

Section: Introductionmentioning

confidence: 99%

“…Particular discrepancies regard effectiveness of the analysis of sonographic features to estimate risk of malignancy in two categories of FL: follicular lesion of undetermined significance - FLUS –group III of cytological diagnoses in the Bethesda system and suspicious for follicular neoplasm – SFN –group IV of cytological diagnoses [1, 2, 7, 10, 14–19]. For the patients with FLUS in cytological outcome this issue is of particular importance, as this result has not been established as a direct indication for surgical treatment [11, 20].…”

Section: Introductionmentioning

confidence: 99%

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The predictive value of sonographic images of follicular lesions – a comparison with nodules unequivocal in FNA – single centre prospective study

et al. 2016

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BackgroundTo determine the diagnostic efficacy of ultrasonographic malignancy risk features (UMRFs) in follicular lesions (FL) in a population with low risk of malignancy in FL and to compare it with a similar analysis in a group of patients with unequivocal cytology (UC): benign lesion (BL) or malignant neoplasm (MN).MethodsPresence of UMRFs (hypoechogenicity, solid echostructure, taller-than-wide shape, pathological vascularization, irregular margins, microcalcifications and macrocalcifications) and their sets were assessed in 322 FL: 202 follicular lesions of undetermined significance (FLUS) and 120 suspicious for follicular neoplasm (SFN) and 300 nodules with UC: 200 BL and 100 MN, subsequently evaluated histopathologically.ResultsCancers were confirmed in 100% nodules in MN group (89.0% of them were papillary carcinomas - PTC), in 6.4% FLUS nodules (69.2% PTC), and in 10.8% SFN nodules (30.8% PTC). In the UC group all UMRFs occurred more frequently in cancers than in benign lesions. In the FL group only calcifications were found in cancers more frequently – macro and microcalcifications together: 34.6 vs. 11.5% (p = 0.001) and isolated macrocalcifications: 26.0 vs. 6.8% (p = 0.001); the presence of those features increased the basic risk of malignancy in FL more than 2 times. The presence of at least 2 of the following URMFs: hypoechogenicity, solid echostructure, any type of calcifications and suspected shape, additionally improved sensitivity.ConclusionsEvaluation of UMRFs in FLs is less effective than in nodules with UC, and its effectiveness decreases parallel to the decrease in percentage of PTCs among malignant neoplasms and to the increase of the percentage of adenomas among benign nodules. The presence of macrocalcifications in such FLs significantly increases the basic risk of malignancy in these nodules.

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Thyroid

2017

Cytopathology of the Head and Neck

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Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology

Abstract: Thyroid nodules with TIRADS scores 4C and 5 should be considered for single definitive surgery in view of the high malignant rate.

Cited by 55 publications

References 30 publications

Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

The predictive value of sonographic images of follicular lesions – a comparison with nodules unequivocal in FNA – single centre prospective study

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