Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults

Abstract

Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.

Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists

“…16,44 The proportion of patients who eventually underwent surgery was similar in both groups (6.1% in those >65 years versus 10.2% in those ≤65 years; p=0.096). 44 Another cross-sectional study of 1,867 patients with thyroid nodules referred to an academic center for an FNA biopsy (median age, 71 years) comparatively assessed the performance of the ACR-TIRADS, ATA and AACE/ACE/AME classification systems in an older adult population. 43 Overall, the majority of patients had benign cytology (83%) and only 3% had cytology consistent with malignancy.…”

“…44 Use of ACR-TIRADS as a rule-out test resulted in the highest avoidance of biopsies in both age groups and had the highest specificity. 16,44 The proportion of patients who eventually underwent surgery was similar in both groups (6.1% in those >65 years versus 10.2% in those ≤65 years; p=0.096). 44 Another cross-sectional study of 1,867 patients with thyroid nodules referred to an academic center for an FNA biopsy (median age, 71 years) comparatively assessed the performance of the ACR-TIRADS, ATA and AACE/ACE/AME classification systems in an older adult population.…”

“…16,42 J o u r n a l P r e -p r o o f A few studies have evaluated the validity of using the aforementioned ultrasoundbased risk stratification systems specifically in older patients. 43,44 .6% vs 10.8% microcalcifications; p=0.005). 44 Use of ACR-TIRADS as a rule-out test resulted in the highest avoidance of biopsies in both age groups and had the highest specificity.…”

“…43,44 .6% vs 10.8% microcalcifications; p=0.005). 44 Use of ACR-TIRADS as a rule-out test resulted in the highest avoidance of biopsies in both age groups and had the highest specificity. 16,44 The proportion of patients who eventually underwent surgery was similar in both groups (6.1% in those >65 years versus 10.2% in those ≤65 years; p=0.096).…”

“…Grani et al, evaluated the diagnostic properties of five ultrasound stratification systems, including the ACR-TIRADS, ATA, K-TIRADS, EU-TIRADS and the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi(AACE/ACE/AME) guidelines 12,34,36,37,40,44. Of 818 thyroid nodules evaluated by ultrasound (median size, 2.1 cm) and referred for FNA biopsy, 57 were found to be…”