Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis

Qiu, Yuxuan; Xing, Zhichao; Liu, Jingyan; Peng, Yulan; Zhu, Jingqiang; Su, Anping

doi:10.1007/s00330-020-07023-0

Cited by 27 publications

(22 citation statements)

References 42 publications

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“…Our findings also suggest the possibility of a future revision of the weights attributed to some ACR-TIRADS system features, with an eventual reduction in the scores associated with solid composition and hypoechogenicity (2 points each), whose impact on the screening process was not particularly relevant in this study ( Table 3 ). Moreover, future improvements in the algorithm might include alternative characteristics, such as elastography, that already demonstrated a potential impact in classification systems used for other organs and districts [ 29 , 30 , 31 , 32 ]. As per previous studies relying on the ACR-TIRADS class, FNA would be indicated in a range of 17% to 40%; in this paper, cases with FNA indicated by the ACR system accounted for 46.5% of the nodules, confirming its high “rule-out” role.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

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Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

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“…In particular, USE has emerged as a valuable tool to discriminate malignant from benign nodules, with diagnostic accuracy greater than TI-RADS, and it should become an additional tool for evaluating thyroid nodule differentiation in combination with conventional US and FNAC, as indicated by the World Federation for Ultrasound in Medicine and Biology (WFUMB) and the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [ 29 , 30 , 31 , 32 ]. Moreover, new elastic imaging technologies, such as the shear-wave elastography and the strain ratio elastography, seem to be more efficient in characterizing thyroid nodules reported as indeterminate in FNAC, and their use is expected to increase in the coming years [ 33 ]. As mentioned, at present, FNAC represents the gold standard in the diagnosis of thyroid nodules because of its accuracy, reproducibility, and cost effectiveness [ 25 ].…”

Section: Thyroid Nodulesmentioning

confidence: 99%

Papillary Thyroid Cancer Prognosis: An Evolving Field

Ulisse

Baldini

Lauro

et al. 2021

Cancers

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Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.

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“…They showed an overall USE sensitivity of 76.6% and a specificity of 86.7%; an RTE (realtime elastography) sensitivity of 71.5% and a specificity of 85.3%; an SRE sensitivity of 81.3% and a specificity of 89.4%; and an SWE sensitivity of 83.8% and a specificity of 87.2%. They concluded that both strain and shear-wave elastography produced good results and they could be combined with conventional US in the coming years [69].…”

Section: Multiparametric Ultrasound (Mpus) Role For Indeterminate Thyroid Nodule Evaluationmentioning

confidence: 99%

Thyroid Nodule Characterization: How to Assess the Malignancy Risk. Update of the Literature

et al. 2021

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Ultrasound (US) is the first imaging modality for thyroid parenchyma evaluation. In the last decades, the role of ultrasound has been improved with the introduction of new US software, such as contrast-enhanced ultrasound (CEUS) and US-elastography (USE). USE is nowadays recognized as an essential part of the multiparametric ultrasound (MPUS) examination, in particular for the indeterminate thyroid nodule with possible fine-needle aspiration cytology (FNAC) number reduction; even if further and larger studies are needed to validate it. More controversial is the role of CEUS in thyroid evaluation, due to its high variability in sensitivity and specificity. Semi-automatic US systems based on the computer-aided diagnosis (CAD) system are producing interesting results, especially as an aid to less experienced operators. New knowledge on the molecular mechanisms involved in thyroid cancer is allowing practitioners to identify new genomic thyroid markers that could reduce the number of “diagnostic” thyroidectomies. We have therefore drawn up an updated representation of the current evidence in the literature for thyroid nodule multiparametric ultrasound (MPUS) evaluation with particular regard to USE, the US CAD system and CEUS.

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Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis

Cited by 27 publications

References 42 publications

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Papillary Thyroid Cancer Prognosis: An Evolving Field

Thyroid Nodule Characterization: How to Assess the Malignancy Risk. Update of the Literature

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