Evaluation of the Diagnostic Performance of EU-TIRADS in Discriminating Benign from Malignant Thyroid Nodules: A Prospective Study in One Referral Center

Кovatcheva, Roussanka; Shinkov, Alexander; Dimitrova, Inna; Ivanova, Ralitsa B.; Vidinov, Kalin; Ivanova, Radina

doi:10.1159/000507575

Cited by 13 publications

(17 citation statements)

References 36 publications

(63 reference statements)

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“…Its performance has been mostly defined as suboptimal, with a higher rate of cancers missed than in adulthood, up to 25% of cases ( 63 , 64 ), suggesting that FNAB should be performed in all the 4 and 5 ACR-TIRADS categories ( 65 – 71 ). EU-TIRADS has also been considered a useful tool for physicians managing adults with thyroid nodules, although its performance should be improved and a FNAB should be performed in all nodules assessed as EU-TIRADS ≥4 ( 50 , 72 – 75 ). Considering the EU-TIRADS, the rate of missed diagnosis of cancer is higher than that found in ACR-TIRADS, reaching up to 37.7% of cases ( 55 , 72 – 79 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

et al. 2022

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BackgroundPediatric thyroid nodules have a lower prevalence but a higher rate of malignancy (ROM) than those in adults. Ultrasound features suspected of malignancy lead to fine needle aspiration biopsy (FNAB) and subsequent cytological determination, upon which management is decided. Based on the characteristics of ultrasound, to standardize clinician decisions and avoid unnecessary FNAB, the European Thyroid Association and the American Radiology College have established guidelines for Thyroid Imaging, Reporting and Data System (EU-TIRADS and ACR-TIRADS) for ROM stratification of thyroid nodules. The aim of this study is to evaluate the diagnostic performance of ACR-TIRADS and EU-TIRADS in pediatric age.Materials and methodsSubjects younger than 18 years of age with thyroid nodules greater than 0.5 cm observed in the 2000-2020 period were included.ResultsData from 200 subjects were collected. The overall ROM was 13%, rising to 26% if nodules with a diameter >1 cm were considered. Patients with a malignant nodule were more likely to have a higher EU-TIRADS score (p=0.03). Missed cancer diagnoses were 26.9%. Using the EU-TIRADS system, 40% of FNABs could have been avoided, while this scoring system would have resulted in FNAB being performed in 12% of cases where the assessment of ultrasound features would not recommend FNAB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.1%, 57.1%, 73.1%, and 50%, respectively. Even considering the ACR-TIRADS, a higher score correlated with a higher ROM (p<0.001). This system missed 6 diagnoses of cancer (23.1%). Using the ACR-TIRADS system, 45.3% of FNABs could have been avoided, while FNAB should have been performed in 12% of cases where it was not recommended by ultrasound characteristics. Sensitivity, specificity, PPV and NPV were 76.9%, 50%, 76.9%, and 42.9%, respectively.ConclusionThe present study confirms the correspondence of the EU-TIRADS and ACR-TIRADS categories with respect to malignancy but indicates not entirely satisfactory performance compared to FNAB alone. However, the use of the two TIRADS systems should be encouraged in multicentre studies to increase their performance and establish paediatric-specific points in the scoring criteria.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

et al. 2022

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“…One recent study by Kovatcheva et al aimed to evaluate the utility of the EU-TIRADS score in the assessment of TNs for FNAB and its ability to reduce unnecessary FNABs (15) . The study was a prospective single-centre analysis and included 741 patients with a total of 942 TNs.…”

Section: Eu-tirads Type Of Change Risk Of Malignancymentioning

confidence: 99%

“…The authors noted that the number of FNABs would decrease by 53.4% if the FNAB criteria were strictly followed. When FNAB indications were followed, the estimated sensitivity, specificity, PPV and NPV of EU-TIRADS were 69.9, 56.3, 16.4 and 93.8%, respectively (15) . The usefulness of EU-TIRADS was also demonstrated in a group of 75 TNs showing increased radioisotope uptake on 18F-FDG PET/CT, which was further evaluated on thyroid ultrasound.…”

Section: Eu-tirads Type Of Change Risk Of Malignancymentioning

confidence: 99%

Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

et al. 2022

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Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

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“…Ultrasonography (US) represents the first-line tool for assessing the nature of thyroid nodules [ 63 ], but the positive predictive values (PPV) of the most applied US-based systems are abundantly lower than 50% [ 64 ]. Conversely, in pediatric subjects, the US risk stratification suffers from poor sensitivity and a high missing malignancy rate [ 65 ].…”

Section: Diagnosticsmentioning

confidence: 99%

Cell-Free DNA Analysis within the Challenges of Thyroid Cancer Management

Marotta

Cennamo

Civita

et al. 2022

Cancers

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Thyroid cancer is the most frequent endocrine malignancy with an increasing incidence trend during the past forty years and a concomitant rise in cancer-related mortality. The circulating cell-free DNA (cfDNA) analysis is a patient’s friendly and repeatable procedure allowing to obtain surrogate information about the genetics and epigenetics of the tumor. The aim of the present review was to address the suitability of cfDNA testing in different forms of thyroid cancer, and the potential clinical applications, as referred to the clinical weaknesses. Despite being limited by the absence of standardization and by reproducibility and validity issues, cfDNA assessment has great potential for the improvement of thyroid cancer management. cfDNA may support the pre-surgical definition of thyroid nodules by complementing invasive thyroid fine needle aspiration cytology. In addition, it may empower risk stratification and could be used as a biomarker for monitoring the post-surgical disease status, both during active surveillance and in the case of anti-tumor treatment.

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Evaluation of the Diagnostic Performance of EU-TIRADS in Discriminating Benign from Malignant Thyroid Nodules: A Prospective Study in One Referral Center

Cited by 13 publications

References 36 publications

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

Cell-Free DNA Analysis within the Challenges of Thyroid Cancer Management

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