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

Abstract

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.

High rates of aggressive features in young Vietnamese females with papillary thyroid carcinoma: Associations with preoperative risk factors

“…Consistent with previous literature, our cohort showed a predominance of younger women [2,17] and papillary histology [4,18] . The TIRADS malignancy risk stratification also aligned with prior studies, with most cancers arising from moderately suspicious nodules [19,20] . However, our study found a high prevalence of capsular invasion (58.7%) and cervical lymph node metastasis (28.5%) among patients with thyroid carcinoma.…”

Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children’s Hospital and a Comprehensive Review of the Pediatric Literature

“…Table 2 summarizes the ROM for the cases of ours that had histologic follow-up in the context of previously published pediatric cohorts [5,6,[45][46][47][48][49][50][51][52], which will be discussed further below.…”

“…For the combined score, the AUC is 0.89, standard error is 0.077, and 95% confidence interval is 0.81-0.97. Although none of the different ultrasound risk stratification systems have been widely adopted worldwide like the Bethesda system has been for reporting thyroid FNA results [29], in pediatrics, the greatest number of general studies (to our knowledge 11, including our own) have involved ACR TI-RADS [5,6,[45][46][47][48][49][50][51][52]. Seven pediatric studies have examined the ATA grading system [5,6,50,61,[80][81][82], and a smaller number of studies have looked at EU-TIRADS [5,50,52,74], K TI-RADS [5,50,83] (one compared the diagnostic performance of the 2021 K TI-RADS criteria to those of 2016 K TI-RADS) [83], Kwak TI-RADS [46,81], or AACE/ACE/AME [5] in children and adolescents.…”

“…Although none of the different ultrasound risk stratification systems have been widely adopted worldwide like the Bethesda system has been for reporting thyroid FNA results [29], in pediatrics, the greatest number of general studies (to our knowledge 11, including our own) have involved ACR TI-RADS [5,6,[45][46][47][48][49][50][51][52]. Seven pediatric studies have examined the ATA grading system [5,6,50,61,[80][81][82], and a smaller number of studies have looked at EU-TIRADS [5,50,52,74], K TI-RADS [5,50,83] (one compared the diagnostic performance of the 2021 K TI-RADS criteria to those of 2016 K TI-RADS) [83], Kwak TI-RADS [46,81], or AACE/ACE/AME [5] in children and adolescents. Some of these studies used the same set of pediatric cases to compare the performance of different ultrasound systems against each other [5,6,46,50,52,81]; for example, Kim et al [5] retrospectively analyzed a total of 277 thyroid nodules from 221 pediatric patients using ACR TI-RADS, ATA, K TI-RADS, EU TI-RADS, and AACE/ACE/AME.…”

Investigating the Value of B-Mode and Contrast-Enhanced Ultrasound Based Radiomics Features in Differentiating Chinese TI-RADS Category 4a and 4b Micro-nodules

“…FNAB is not widely accepted by patients because it is an invasive examination and its uncertain results. [6,7] The progressive knowledge analytics contributed by arti cial intelligence (AI) has hugely dilated researchers' capability for purposeful discovery. The application of machine learning (ML), a subset of AI, gives novel clinical insights for enhancing prognosis and diagnosis accuracy.…”