Combination of ultrasound elastography with TI-RADS in the diagnosis of small thyroid nodules (≤10 mm): A new method to increase the diagnostic performance

Du, Yanran; Ji, Chen-Li; Wu, Yang; Gu, Xuefan

doi:10.1016/j.ejrad.2018.10.024

Cited by 23 publications

(14 citation statements)

References 23 publications

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“…Our study demonstrates that 97% of the malignant TNs presented with a high-risk Kwak-TIRADS (4C or 5) or EU-TIRADS (EU 5) classification and that 100% presented with an ACR TI-RADS TR4 or 5. These high sensitivities are comparable to the results of Du et al, where the Kwak-TIRADS alone and in combination with ultrasound elastography was tested in small TNs [20]. However, contrary to our study they summarized Kwak-TIRADS 4B-5 as malignant, because the prevalence of malignancy for Kwak-TIRADS 4B was remarkably high: 70.5% vs. 16.7% in our study and 9.2% in the data from the original paper of Kwak et al The accuracy for Kwak-TIRADS alone was found to be 83.8%, slightly higher than our results for Kwak-TIRADS.…”

Section: Discussionsupporting

confidence: 85%

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

Schenke

Klett²,

Seifert

et al. 2020

JCM

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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.

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Section: Discussionsupporting

confidence: 85%

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

Schenke

Klett²,

Seifert

et al. 2020

JCM

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“…First, the diagnostic cut-offs of the four guidelines, ACR-TIRADS TR5, Kwak-TIRADS 4C, KTA/KSThR-TIRADS 5, and EU-TIRADS 5 were identified, which was similar to that of Gao, Ali Murat Koc ( 14 , 20 ). However, Simone indicated that the diagnostic cut-off value of ACR-TIRADS is TR4, while Du showed that the diagnostic cut-off value of Kwak-TIRADS is 4B ( 21 , 22 ). They also showed that the malignancy rate of the two nodule grades is very high, possibly due to the deviations in the data source.…”

Section: Discussionmentioning

confidence: 99%

Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study

Aiyun

Guo

et al. 2021

Front. Endocrinol.

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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.

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“…However, in contrast, differentiating benign and malignant TI-RADS category 4 nodules is difficult [ 7 , 8 ]. The ultrasonographic features of these thyroid nodules are complex [ 9 – 11 ], and the characteristics of conventional US images often overlap. The conventional ultrasound features of some nodules were shown to be benign, and the pathology of the surgery was confirmed to be malignant (Fig.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of multimodal ultrasound imaging in differentiating benign and malignant TI-RADS category 4 nodules

et al. 2019

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Background Differential diagnosis of benign and malignant thyroid imaging reporting and data system category 4 (TI-RADS-4) nodules can be difficult using conventional ultrasound (US). This study aimed to evaluate whether multimodal ultrasound imaging can improve differentiation and characterization of benign and malignant TI-RADS-4 nodules. Methods Multimodal ultrasound imaging, including US, superb microvascular imaging (SMI), and real-time elastography (RTE), were performed on 196 TI-RADS-4 nodules (78, benign; 118, malignant) in 170 consecutive patients. The sensitivity, specificity, accuracy, false negative rate (FNR), and false positive rate (FPR) of each single method and that of multimodal US imaging were determined by comparison with surgical pathology results. Results The sensitivity, specificity, accuracy, FNR, and FPR for US were 65.25%, 69.23%, 66.84%, 34.75%, 30.77%, respectively; for SMI were 77.97%, 93.59%, 84.18%, 22.03%, 6.41%, respectively; RTE, 80.51%, 84.62%, 82.14%, 19.49%, 15.38%; and for multimodal US imaging were 94.08%, 87.18%, 91.33%, 6.93%, 12.82%, respectively. The areas under the received operating characteristic curve for US, SMI, RTE, and multimodal US imaging in evaluating benign and malignant TI-RADS-4 nodules were 67.2%, 84.40%, 86.60%, and 95.50%, respectively. Conclusions The initial clinical results suggest that multimodal US imaging improves the diagnostic accuracy of TI-RADS-4 nodules and provides additional information for differentiating malignant and benign nodules.

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Combination of ultrasound elastography with TI-RADS in the diagnosis of small thyroid nodules (≤10 mm): A new method to increase the diagnostic performance

Cited by 23 publications

References 23 publications

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study

Diagnostic value of multimodal ultrasound imaging in differentiating benign and malignant TI-RADS category 4 nodules

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