Differences between ATA, AACE/ACE/AME and ACR TI-RADS ultrasound classifications performance in identifying cytological high-risk thyroid nodules

Pantano, Angelo Lauria; Maddaloni, Ernesto; Briganti, Silvia; Anguissola, Giuseppina Beretta; Perrella, Eleonora; Taffon, Chiara; Palermo, Andrea; Pozzilli, Paolo; Manfrini, Silvia; Crescenzi, Anna

doi:10.1530/eje-18-0083

Cited by 99 publications

(77 citation statements)

References 34 publications

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“…). It is recognized that ATA has limitations in classifying isoechoic and hyperechoic nodules with malignant features, as well as the relevant number of malignancies in this group of nodules . Given the high frequency of these findings among FTC, future guidelines should incorporate these results.…”

Section: Discussionmentioning

confidence: 99%

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Castellana

Piccardo

Virili

et al. 2020

Cancer Cytopathology

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BACKGROUND: Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine needle aspirations (FNAs) of thyroid nodules. These systems were designed primarily to identify papillary thyroid carcinomas, thus their performance on follicular thyroid carcinoma (FTC) is debatable. The present study was undertaken to investigate the accuracy of RSSs in selecting FTCs for FNA. METHODS: Patients with FTC who underwent US examinations between 2012 and 2018 in 2 institutions were selected. US images were reviewed retrospectively, and FTCs were reclassified according and Thyroid Imaging Reporting and Data System (TIRADS). Risk class and indication for FNA were assessed. RESULTS:Forty-five FTCs from 45 consecutive patients were included in the study. The median tumor diameter was 32 mm (range, 11-100), and ovoid isoechoic nodule with or without lobulated margins was the most frequent presentation. When FTCs were classified according to RSSs, the most common categories were intermediate and high risk, though 1 case in 3 was not classifiable. FTCs were classified as high risk/high suspicion/malignant in 11% to 74% of cases, with a statistically significant difference among the systems. FNA was indicated in 69% to 100% of cases, with good agreement among AACE/ACE/AME, ACR-TIRADS, and TIRADS. CONCLUSION: Current RSSs show high performance in selecting FTCs for FNA. This result is mainly due to the dimensional RSSs cutoffs indicating FNA. On the contrary, given the reported unsuspicious echo-structural presentation of FTC and the recognized limitation of cytological assessment to detect it, caution is advised when using US to manage cytologically indeterminate nodules. Cancer Cytopathol 2020;128:250-259.

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Section: Discussionmentioning

confidence: 99%

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Castellana

Piccardo

Virili

et al. 2020

Cancer Cytopathology

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“…Originalkohorte mit 3650 Knoten [29] TI-RADS nach Park [27] Muster + Punktesumme [32], [33], [34], [35], [37], [39], [40] AACE / ACE / AME 2016 [30] Muster-basiert [48]. Eine glatte oder lediglich unscharfe Begrenzung zwischen solidem und zystischem Anteil weist auf Benignität hin, eine mikrolobulierte Begrenzung auf Malignität, v. a. in Kombination mit Mikrokalzifikationen des soliden Anteils [49], [50].…”

Section: Alleunclassified

“…Dignitätsbeurteilung: Taller-than-wide ist zwar ein wenig sensitives, aber hochspezifisches und hochsuspektes Kriterium [56], [57]. [33], [35], [37], [65].…”

Section: Alleunclassified

TI-RADS und andere sonografische Klassifikationssysteme für Schilddrüsenknoten

2020

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Mehrere Arbeitsgruppen und Fachgesellschaften haben in den letzten Jahren Klassifikationssysteme für die sonografische Dignitätsbeurteilung von Schilddrüsenknoten vorgeschlagen, häufig unter dem Überbegriff „TI-RADS“. Diese Systeme zielen auf eine vereinheitlichte und möglichst umfassende Beurteilung von Knoten anhand definierter sonographischer Kriterien ab. Für verschiedene Befundkonstellationen leitet sich so eine jeweilige Malignomwahrscheinlichkeit ab, und die Rate an unnötigen Feinnadelpunktionen kann nachweislich reduziert werden. Es soll zudem verhindert werden, dass wichtige Einzelaspekte der Malignitätsabschätzung im Befund nicht adressiert werden. Der Beitrag stellt eine Übersicht der relevanten Klassifikationssysteme dar, erläutert die Definitionen der einzelnen sonographischen Kriterien unterstützt durch Bildbeispiele und fasst die aktuelle Evidenz zu den genannten Systemen zusammen.

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“…Ultrasound is a widely accepted diagnostic method for examining thyroid [23][24][25][26][27], but several studies have reported that it is less useful in differentiating between PTL and HT [28]. Ultrasound suffers the limitations of being non-specific [29][30][31]. CT has been introduced to an augment technique of diagnosis of thyroid disease [32].…”

Section: Discussionmentioning

confidence: 99%

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

Luo

Huang

Zhou

et al. 2019

Endokrynologia Polska

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Introduction: The aim of the study is to investigate the usefulness of ultrasound combined with computed tomography (CT) for distinguishing between primary thyroid lymphoma (PTL) and Hashimoto's thyroiditis (HT). Material and methods: The investigation was conducted retrospectively in 80 patients from January 2000 to July 2018. All patients underwent pathological tests to be classified into one of two groups: PTL group and HT group. The cutoff value of CT density was determined using receiver-operating characteristic (ROC) curve analysis. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosis for thyroid by CT alone, ultrasound alone, and the combination of CT plus ultrasound were calculated. Results: Of the 80 study patients, 27 patients were PTL and 53 patients were HT. Mean CT density had a sensitivity of 90.6% and a specificity of 88.9% at a cutoff value of 53.5 HU, with area under the curve (AUC) 0.88. Ultrasound combined with CT had the highest specificity, accuracy, and PPV compared with CT alone and ultrasound alone (p value < 0.05). Conclusions: Features such as extremely hypoechogenicity, enhanced posterior echo, cervical lymphadenopathy in ultrasound image, and linear high-density strand signs, and very low density in CT imaging have high sensitivity and specificity in thyroid lymphoma. Therefore, ultrasound combined with CT may be useful for distinguishing between PTL and HT.

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Differences between ATA, AACE/ACE/AME and ACR TI-RADS ultrasound classifications performance in identifying cytological high-risk thyroid nodules

Abstract: The ACR TI-RADS classification system has the highest area under the ROC curve for the identification of cytological high-risk nodules. ATA classification leaves 'unclassified' nodules at relatively high risk of malignancy.

Cited by 99 publications

References 34 publications

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?

TI-RADS und andere sonografische Klassifikationssysteme für Schilddrüsenknoten

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

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