Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma–A Meta-Analysis

Borowczyk, Martyna; Woliński, Kosma; Więckowska, Barbara; Jodłowska-Siewert, Elżbieta; Szczepanek‐Parulska, Ewelina; Verburg, Frederik A.; Ruchała, Marek

doi:10.3390/cancers13050938

Cited by 24 publications

(18 citation statements)

References 60 publications

(19 reference statements)

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“…Therefore, we believe that all six systems assessed in this study are effective tools to select FTC for FNA in clinical practice. In fact, previous studies have shown that follicular neoplasms are large [22][23][24][25][26][27]. The mean maximum diameter of FTC (3.9 ± 2.1 cm) in our study was higher than any threshold proposed for ultrasound-based malignancy risk stratification systems.…”

Section: Discussioncontrasting

confidence: 63%

“…In our study, FNA was considered indicated for 65.3% to 93.1% of all FTAs and for 62.2% to 89.7% of FTAs sized ≤ 4 cm. We believe that this result is mainly due to the large size of follicular neoplasms [22][23][24][25][26][27]. Furthermore, our study showed that the unnecessary biopsy rates with use of "pattern-based" systems were higher than those with use of "score-based" systems irrespective of the lesion size because of the different criteria for determining the indications for biopsy.…”

Section: Discussionmentioning

confidence: 87%

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Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

et al. 2022

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Objectives To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy. Methods Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system. Results The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511–0.611). The missed biopsy rates were 9.0–22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2–4 cm were 16.2–35.1% and 0–20.0%, respectively. Unnecessary biopsy rates were 65.3–93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2–89.7%. Conclusion The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms. Key Points • Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 87%

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

et al. 2022

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“…An interrupted halo, this significant sonographic characteristic, was confirmed by Kaoru Kobayashi et al 's study 17 which showed that tumor protrusion on ultrasonography was a strongly suggestive finding of FTC. A meta-analysis by Borowczyk et al 18 also suggested that the most crucial characteristic connected with an increased risk of FTC was the tumor protrusion. Our conclusion was also consistent with the studies of Zhang et al 19 and Solbiati et al 20 .…”

Section: Discussionmentioning

confidence: 99%

The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma

Li¹,

Song²,

Lan³

et al. 2021

CMAR

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Purpose: Differentiation between follicular thyroid carcinomas (FTCs) and follicular thyroid adenomas (FTAs) is difficult and the sonographic features of FTC are not yet fully established. The purpose of this study is to explore the sonographic features of FTC and the value of sonography in differentiating FTCs from FTAs. Patients and Methods: A total of 28 pathologically proven FTCs and 53 FTAs in 78 patients who were performed thyroid surgery were included in this retrospective study. The sonographic features of each tumor including an interrupted halo, satellite nodule(s) with or without halo ring, local irregularity of margin and cluster of grapes sign were evaluated. A mode image of FTC halo was built up in our study. The frequencies of the sonographic features were compared by chi-square test or Fisher exact test between FTCs and FTAs. The relative risk of malignancy was assessed by logistic regression analysis. Results: Logistic regression analysis showed that a thick, irregular and/or interrupted halo with or without satellite nodule(s), hypoechoic or marked hypoechoic echogenicity, a predominantly solid pattern, cluster of grapes sign, micro-or macro-calcifications, rim calcifications correlated with significant increases in relative risk for FTCs (odds ratio 11.48 (1.37-96.56), 6.74 (1.05-43.30), 17.51 (1.78-172.53), 9.55 (1.44-63.46), 9.36 (1.25--70.15) and 17.45 (1.04-292.65), respectively, p<0.05). Two new sonographic features, an interrupted halo and satellite nodule(s) with or without halo ring, can only be found in FTCs. Conclusion:An interrupted halo and satellite nodule(s) with or without halo ring are specific sonographic features for FTCs. Sonography could play a role in differentiating follicular thyroid carcinoma from adenoma.

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“…The nodules were classified as C-TIRADS 4A, which were adjusted to one level lower after CEUS found the nodules to be benign. A study reported that ultrasound imaging of this pathological type may misdiagnose nodules as follicular adenoma [ 10 ]. However, careful observation of the capsule after the enhancement of the aforementioned nodules showed intermittent blur.…”

Section: Discussionmentioning

confidence: 99%

Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules

Cheng

Rong

et al. 2022

International Journal of Endocrinology

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Objectives. To explore the value of applying contrast-enhanced ultrasound (CEUS) in adjusting the classification of category 4 nodules in the Chinese-Thyroid Imaging Report and Data System (C-TIRADS). Methods. The data of preoperative conventional ultrasound and CEUS examinations of 125 C-TIRADS 4 nodules in 109 patients were retrospectively analyzed. We divided the thyroid nodules into two groups based on whether recommend by the guide fine-needle aspiration (FNA). Group I included C-TIRADS 4A nodules with a maximum diameter ≤15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter ≤10 mm, and Group II included C-TIRADS 4A nodules with a maximum diameter >15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter >10 mm. In CEUS, thyroid nodules showing suspicious malignant features such as hypoenhancement or early washout were adjusted to a level higher in the C-TIRADS classification; thyroid nodules showing possible benign features such as iso- or hyperenhancement were adjusted to a level lower; and thyroid nodules showing no enhancement were adjusted to C-TIRADS 3. Taking the pathological results as the gold standard, the receiver operating characteristic (ROC) curves of the C-TIRADS classification before and after the adjustment based on CEUS were plotted, and the diagnostic efficiency was compared. Results. The sensitivity, specificity, accuracy, and positive and negative predictive values of the C-TIRADS classification for the diagnosis of thyroid nodule malignancy before the adjustment based on the CEUS results were 83.6%, 63.8%, 74.4%, 72.7%, and 77.1%, respectively, and these values were 91.0%, 82.8%, 87.2%, 85.9%, and 88.9%, respectively, after the adjustment. The area under the ROC curve (AUC) was 0.737 and 0.869, respectively, showing a significant difference (Z = 3.288, P = 0.001 ). The diagnostic efficiency of C-TIRADS classification after the adjustment based on the CEUS results in both groups was improved compared with the result before the adjustment, and the difference in Group II was significant (Z = 2.931, P = 0.003 ). Conclusions. CEUS significantly improved the diagnostic performance in the adjustment of C-TIRADS 4 nodule classification, especially for the nodules which needs FNA recommended by the C-TIRADS.

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Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma–A Meta-Analysis

Cited by 24 publications

References 60 publications

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma

Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules

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