Do ACR TI-RADS scores demonstrate unique thyroid molecular profiles?

Abstract

Purpose: Our study aimed to examine the molecular profiles of cytologically indeterminate thyroid nodules stratified by American College of Radiology (ACR) Thyroid imaging reporting and data system (TI-RADS) categories and to determine whether certain ultrasonographic features display particular molecular alterations. Methods: We performed a retrospective review of cases from 1/1/2016-4/1/2018. Cases with in-house ultrasound, fine needle aspiration (FNA) Thyroid Bethesda Reporting System for Cytology (TBSRTC) diagnoses, molecular testing, and surgery were included. All cases were diagnosed as TBSRTC indeterminate categories. Ultrasound studies were retrospectively reviewed and assigned TI-RADS scores (TR1-TR5) by board-certified radiologists. Final diagnoses were determined based on the surgical resection pathology. Binary logistic regression analysis was used to study whether demographics, TI-RADS levels and TBSRTC diagnoses were associated with ThyroSeq molecular results. Results: 81 cases met the inclusion criteria. The most common alteration across all TI-RADS categories was RAS mutation (TR2 2/2; TR3 10/19, TR4 13/44, and TR5 8/16), which did not stratify with any particular TI-RADS category. Only TR4 and TR5 categories displayed more aggressive mutations such as BRAF-V600E and TERT. ThyroSeq results were positively correlated with thyroid malignancy when non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was categorized in the malignant category for outcome (OR 6.859; p<0.01), but not in the Thyroid Malignancy category when NIFTP was removed from the malignancy category. Echogenicity scores were found to be negatively correlated with ThyroSeq results in thyroid nodules (OR 0.162; P<0.01). Conclusions: Higher risk molecular alterations tended to stratify with the higher TI-RADS categories.

Risk of malignancy in cytologically indeterminate thyroid nodules harboring thyroid stimulating hormone receptor mutations

“…Thyroseq reports TSHR mutations as "currently negative" with a <10% probability of a low-risk cancer or NIFTP and a recommendation of active surveillance (25). An exhaustive literature search to ascertain the ROM in operated TSHR mutated ITNs reveals 3/29 malignancies reported for a point estimate of 10% cancer rate (4,11,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Almost all these studies utilized the Thyroseq platform, thus it is reasonable to assume there were other concerning clinical or ultrasound features prompting a recommendation for surgery given the low risk ascribed to TSHR mutations.…”

Study on Diagnosing Thyroid Nodules of ACR TI-RADS 4~5 with Multi-Modal Ultrasound Radiomics Technology

“…However, due to differences in operator experience and the de nition of ultrasound features, its accuracy may vary. In order to standardize management [12,13] , Horvath et al [14] de ned ultrasound features of suspicious malignant thyroid nodules and developed the Thyroid Imaging Reporting and Data System (TI-RADS) [15] . This system provides standardized risk strati cation of nodules to guide clinical decision-making.…”

Study on diagnosing thyroid nodules of ACR TI‐RADS 4–5 with multimodal ultrasound radiomics technology

“…However, due to the differences in operator experience and the definition of US features, its accuracy may vary. In order to standardize management, 12,13 Kwak et al 14 defined US features of suspicious malignant thyroid nodules and developed the Thyroid Imaging Reporting and Data System (TI‐RADS) 15 . This system provides standardized risk stratification of nodules to guide clinical decision‐making.…”

“…In order to standardize management, 12,13 Kwak et al 14 defined US features of suspicious malignant thyroid nodules and developed the Thyroid Imaging Reporting and Data System (TI-RADS). 15 This system provides standardized risk stratification of nodules to guide clinical decision-making. Additionally, the American College of Radiology (ACR) has also released the ACR-TI-RADS, a thyroid nodule classification system based on TI-RADS, which further standardizes diagnostic criteria.…”