Accuracy of international ultrasound risk stratification systems in thyroid lesions cytologically classified as indeterminate

Trimboli, Pierpaolo; Fulciniti, Franco; Zilioli, Valentina; Ceriani, Luca; Giovanella, Luca

doi:10.1002/dc.23651

Cited by 41 publications

(38 citation statements)

References 19 publications

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“…In this regard, different international societies have published their thyroid ultrasound risk stratification systems to give thyroidologists a practical tool to use [2, 3, 11, 12]. However, a recent study by Trimboli et al [20] looked at the accuracy of international risk stratification systems in thyroid lesions classified as indeterminate. Poor accuracy (up to 54%) and specificity (up to 19%) were recorded among all reporting systems.…”

Section: Discussionmentioning

confidence: 99%

Indeterminate Thyroid Nodules: A Pragmatic Approach

Khalil¹,

Dina²,

Meeran³

et al. 2017

Eur Thyroid J

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Background: Fine needle aspiration (FNA) cytology fails to provide a conclusive diagnosis in a subset of thyroid lesions labeled as “indeterminate” (Thy3). In this study, we aimed at ascertaining the prevalence of Thy3 thyroid nodules in a hitherto unreported ethnic group (residents of the United Arab Emirates). Methods: We retrospectively examined 688 FNA of the thyroid performed on 584 patients. Samples were reported using the Royal College of Physicians’ (RCP) Thy classification. The results of the FNA were correlated with the final surgical specimens. Ultrasonography (US) risk stratification was calculated using a web-based US risk of malignancy calculator. Results: Overall sample adequacy was 97%. The indeterminate group Thy3 was found in 7% of the samples. The overall risk of malignancy in the Thy3 category was 20%. This risk was very similar in the 2 subgroups of Thy3 (17% in Thy 3a and 22% in Thy3f). Subdividing the Thy3 group into subgroups becomes less necessary if the US scoring is <24.5% since the negative predictive value, in this case, is 100%. Applying this criterion to our population would have had the potential of reducing the percentage of patients referred to surgery from 61 to 43%. Conclusions: Proper risk stratification of Thy3 lesions should be based on the combined risk assessment of clinical, cytological, radiological, and molecular data. Such a pragmatic approach is expected to reduce the percentage of inappropriate referrals to surgery.

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Section: Discussionmentioning

confidence: 99%

Indeterminate Thyroid Nodules: A Pragmatic Approach

Khalil¹,

Dina²,

Meeran³

et al. 2017

Eur Thyroid J

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“…Some studies have demonstrated the use of ultrasound to predict the risk of malignancy in Bethesda III and IV thyroid nodules during the initial US‐FNA . However, one study demonstrated that the thyroid ultrasound risk stratification system has poor specificity and accuracy for classifying indeterminate lesions . Another study reported that age and gender, but not ultrasound characteristics, influence the decision to perform surgery in AUS/FLUS patients .…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] However, one study demonstrated that the thyroid ultrasound risk stratification system has poor specificity and accuracy for classifying indeterminate lesions. 13 Another study reported that age and gender, but not ultrasound characteristics, influence the decision to perform surgery in AUS/FLUS patients. 14 Since then, no clear guidelines have been established to manage Bethesda III and IV nodules.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.

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“…Even if these ultrasound risk stratification system have been proposed for the initial assessment of thyroid nodules and to select nodules at higher risk of malignancy, more recently 2 articles have investigated their reliability in predicting malignancy in a specific series of indeterminate thyroid lesions. In these 2 studies, more ultrasound risk stratification systems were compared and the ATA system emerged as the most accurate one . Thus, the purpose of this study was evaluate the performance of the 5‐point ATA scoring systems to carry out the predictivity tests of each category.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound parameters have been largely investigated in this context but published data are still controversial . The use of the ATA ultrasound system could have a very high impact in this context, as very recently reported in 2 studies …”

Section: Introductionmentioning

confidence: 99%

American Thyroid Association ultrasound system for the initial assessment of thyroid nodules: Use in stratifying the risk of malignancy of indeterminate lesions

et al. 2017

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Accuracy of international ultrasound risk stratification systems in thyroid lesions cytologically classified as indeterminate

Abstract: Even if international US-RSS have suboptimal accuracy in indeterminate thyroid nodules, high sensitivity can be obtained using ATA system with specific dimensional cut-offs. Diagn. Cytopathol. 2017;45:113-117. © 2016 Wiley Periodicals, Inc.

Cited by 41 publications

References 19 publications

Indeterminate Thyroid Nodules: A Pragmatic Approach

Indeterminate Thyroid Nodules: A Pragmatic Approach

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

American Thyroid Association ultrasound system for the initial assessment of thyroid nodules: Use in stratifying the risk of malignancy of indeterminate lesions

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