Retrospective Application of the 2015 American Thyroid Association Guidelines for Ultrasound Classification, Biopsy Indications, and Follow-up Imaging of Thyroid Nodules: Can Improved Reporting Decrease Testing?

Abstract

Introduction Thyroid ultrasound has been widely used to determine which nodules need further investigation. The goal of this study is to determine if using an ultrasonographic features checklist based on 2015 American Thyroid Association (ATA) guidelines can improve reporting and decrease unnecessary further testing. Methods In this retrospective study, ultrasonographic images of all nodules biopsied at our institution in 2014 and 2015 were reviewed by radiologists blinded to fine needle aspiration (FNA) biopsy result using a checklist. The checklist was prepared based on 2015 ATA guidelines. The ultrasonographic characteristics of thyroid nodules were compared with the result of biopsy to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for predicting malignancy. Radiologists also made an overall recommendation on need for FNA. Results A total of 425 thyroid nodule ultrasound scans were reviewed by radiologists. Biopsy results of 31 nodules were malignant and 394 were non-malignant. Malignant nodules showed higher frequency of solid composition, hypoechoechogenicity, and cervical lymph node involvement compared to benign nodules. Solid nodule composition had the highest PPV (13%) and NPV (94.7%). Extra-thyroid extension had the highest specificity (90.1%). Lesion vascularity had the highest sensitivity (83.8%), followed by hypoechogenicity (65.6%). Overall, the checklist had a positive predictive value of 9%, negative predictive value of 97.5%, sensitivity of 96.8%, and specificity of 11.14%. Radiologists determined that 10% of the nodules were very low-risk and did not require FNA. Conclusion Using a checklist based on 2015 ATA guideline thyroid nodule ultrasonographic features is a sensitive tool with high NPV to predict benign thyroid nodule, thereby preventing unnecessary FNAs.

The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls

“…A recent meta-analysis [39], including 12 studies [7,13,26,[40][41][42][43][44][45][46][47][48] representing 18,750 nodules, evaluated the ability of 5 US RSSs (AACE, ACR, ATA, EU-TIRADS, K-TIRADS) for the appropriate selection of thyroid nodules for FNA. Diagnostic odds ratio, representing the test performance and corresponding to the odds of the FNA being indicated in a malignant nodule compared to the odds of the FNA being indicated in a benign one, were calculated for each US RSS.…”

Modern approaches to the diagnosis and treatment of nodular nontoxic lesions of the thyroid gland

“…Ñë³ä çàóâàaeèòè, ùî ó ïàö³ºíò³â ³ç âóçëîâèì çîáîì òàêîae ïîòð³áíî ïðîâåñòè äîñë³äaeåííÿ ð³âíÿ ñèðîâàòêîâîãî êàëüöèòîí³íó ç ìåòîþ âè-êëþ÷åííÿ ìåäóëÿðíîãî ðàêó ÙÇ: öÿ ôîðìà ðàêó òðàïëÿºòüñÿ ó 04-1,4% âñ³õ çëîÿê³ñíèõ íîâîóòâîðåíü ó ÙÇ, à â 20-30% -öå ñ³ìåéíà (ñïàäêîâà) ôîðìà, ùî ñóïðîâîäaeóºòüñÿ äîñèòü ðàíí³ì â³ääàëåíèì ìåòàñòàçóâàííÿì. Äëÿ äèôåðåíö³éíî¿ ä³à´íîñòèêè õâîðèõ ³ç äîá-ðîÿê³ñíèìè àáî çëîÿê³ñíèìè âóçëàìè çàñòîñîâóþòü óëüòðàñîíî´ðàô³þ (ÓÑ¥) [4,8,11], òîíêîãîëêîâó àñï³ðàö³éíó á³îïñ³þ (ÒÀÏÁ) ³ç ïîäàëüøèì öèòîëî´³÷íèì äîñë³äaeåííÿì ïóíêö³éíîãî ìàòåð³àëó [4] àáî ïóíêö³þ ãîëêàìè á³ëüøîãî ä³àìåòðó ç îòðèìàííÿì ìàòå-ð³àëó äëÿ ã³ñòîëî´³÷íîãî äîñë³äaeåííÿ [20]. Çà äîïîìîãîþ óëüòðàçâóêîâî¿ êîëüîðîâî¿ äîï-ïëåðî´ðàô³¿ âèçíà÷àþòü âàñêóëÿðèçàö³þ ïà-ðåíõ³ìè ÙÇ, à òàêîae îñîáëèâîñò³ âàñêóëÿðè-çàö³¿ âóçë³â.…”