Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules—Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

Abstract

Background: To validate the European Thyroid Imaging and Reporting Data System EU-TIRADS classification in a multi-institutional database of thyroid nodules by analyzing the obtained scores and histopathology results. Methods: A total of 842 thyroid lesions (613 benign, 229 malignant) were identified in 428 patients (mean age 62.7 years) and scored according to EU-TIRADS, using ultrasound examination. In all tumors, histopathological verification was performed. Results: In EU-TIRADS 2 (154 nodules) all nodules were benign; in EU-TIRADS 3, only 3/93 malignancies were identified. In EU-TIRADS 4, 12/103 were malignant, and in EU-TIRADS 5 (278 benign vs. 214 malignant). The malignant nodules that would not have qualified for biopsy were: EU-TIRADS 3, 2/3 (67%) malignancies were <20 mm, in EU-TIRADS 4, 7/12 (58%) were <15 mm. In EU-TIRADS 5, 72/214 (34%) were <10 mm; in total, 81/229 (36%) malignant lesions would have been missed. The cutoff between EU-TIRADS 3/4 had sensitivity of 100%, specificity of 25.1%. Using cutoff for EU-TIRADS 5, 93.4%, 54.6%, respectively. Conclusion: The application of EU-TIRADS guidelines allowed us to achieve moderate specificity. The vast majority of malignancies in EU-TIRADS 3, 4, and 5 would not have been recommended for biopsy because having a smaller size than that proposed classification. Recently, the European Thyroid Association (ETA) published the novel European Thyroid Imaging and Reporting Data System (EU-TIRADS), based on the ATA (American Thyroid Association) guidelines, Korean guidelines, American Association of Clinical Endocrinologists (AACE) guidelines, and a review of recent studies [11].The goal of our study was to validate the EU-TIRADS system in a multi-institutional database of thyroid nodules by analyzing the relationship between the obtained scores and the histopathology results. Furthermore, we aimed to evaluate the effectiveness of the EU-TIRADS scale in determining which nodules should be biopsied. To the best of our knowledge, this analysis constitutes the unique multicenter large cohort analysis of the diagnostic performance of the EU-TIRADS scale in a previously iodine-deficient region.

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules

“…Recent studies have demonstrated that, when using the EU-TIRADS classification, the sensitivity is satisfactory, but specificity might still be insufficient. Dobruch-Sobczak et al have reported 98.7% sensitivity, 39.8% specificity, 38.0% PPV, and 98.8% NPV in nodules assessed as EU-TIRADS ≥4 [12]. Comparable results were obtained by Schenke et al for small thyroid nodules (<10 mm) and presented as follows: 97.4%, 49.3%, 67.9%, and 94.4%, respectively [21].…”

“…Difficulties with the interpretation of US findings often lead to redundant FNAB or even diagnostic surgery. Recently, the European Thyroid Imaging Reporting and Data System (EU-TIRADS) was established to facilitate standardization and provide a simple lexicon for distinguishing between benign and malignant TNs and to reduce the number of unnecessary invasive interventions (FNAB, thyroidectomy) [12]. A meta-analysis of seven studies, evaluating 5672 thyroid nodules, indicated that stratifying the risk of thyroid nodules by EU-TIRADS showed high performance, while the prevalence of malignancy in EU-TIRADS class 5 was equal to 76.1% [13].…”

Diagnostic Value of Six Thyroid Imaging Reporting and Data Systems (TIRADS) in Cytologically Equivocal Thyroid Nodules

“…It leads to a better stratification of the risk for a nodule and allows choosing the threshold at the level of category 4 or 5 depending on the aim of a user of this system—optimization of SEN vs. optimization of SPC. Timborli et al also indicated the discrimination value of EU-T [ 41 ] and Dobruch-Sobczak et al reported high SEN of that system in a population that had been exposed to iodine deficiency [ 42 ]. Advantages similar to that of EU-T can be also found for K-T, ATA-T, ACR-T and Kw-T.…”

Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue

“…Ultrasonography (US) is a readily available, noninvasive tool used in neck imaging and the first step in the diagnostic algorithm of thyroid nodules [ 1 , 2 ]. However, US results highly depend on the interpretation and experience of the operator, with the sensitivity and specificity values ranging between 65.3 and 81.9%, and 60.7 and 68.9%, respectively [ 3 ].…”