The relationship between ultrasound-based TIRADS and BETHESDA categories in patients undergoing thyroid biopsy

Aksoy, Süleyman Hilmi; Uygun, Özlem; Yurdaışık, Işıl; Ates, Lora Esberk; Aydın, Selami

doi:10.1007/s10238-021-00779-9

Cited by 3 publications

(3 citation statements)

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“…Most existing studies evaluating ACR-TIRADS in adulthood have determined that the system score is useful for managing thyroid nodules and reducing the number of unnecessary FNAB, while some concerns remain about its reliability in evaluating nodules of indeterminate cytology (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Among the different TIRADS, ACR-TIRADS was ranked as the best performing classification for identifying high-risk nodules and unnecessary FNABs (35, 36, 52-60), although a missed malignancy diagnosis occurred in 10.2-20% of cases in which ACR-TIRADS have not indicated the need for FNAB (46,55,61).…”

Section: Discussionmentioning

confidence: 99%

“…Most existing studies evaluating ACR-TIRADS in adulthood have established that the score is useful for managing thyroid nodules and reducing the number of unnecessary FNAB procedures, while there are some concerns about its reliability for the evaluation of nodules with indeterminate cytology (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Among the different TIRADS classification systems, ACR-TIRADS has been indicated as the most accurate classification system for identifying high-risk nodules and preventing most unnecessary FNABs (35, 36, 52-60), although in 10.2-96 20% of cases a failure to diagnose malignancy has been reported (46,55,61).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…In order to simplify and standardize the evaluation and reporting of US characteristics of a thyroid nodule, the American College of Radiology has introduced the ACR TI-RADS reporting system consisting of five grades of malignancy susception ( 15 ). ACR TI-RADS has been utilized in evaluating thyroid nodules of different cytopathologic categories and has proven its efficacy in clinical practice ( 37 ). However, the predictive role of ACR TI-RADS in AUS/FLUS subclassifications is unclear.…”

Section: Discussionmentioning

confidence: 99%

Clinico-cytopathological subcategorization in thyroid nodules of atypia of undetermined significance/follicular lesion of undetermined significance using the TIRADS and Bethesda classifications

Babajani,

Rahmani,

Raoufi

et al. 2023

Front. Endocrinol.

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IntroductionBethesda category III – atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous class of the Bethesda system for thyroid nodules. In order to clarify the therapeutic road for clinicians, this category was subclassified based on the cytopathological features. In this study, we evaluated the risk of malignancy, surgical outcome, demographic characteristics, and correlation of ultrasound features with the final outcome in patients with thyroid nodules based on AUS/FLUS subclassification.MethodAfter evaluating 867 thyroid nodules from three different centers, 70 (8.07%) were initially diagnosed as AUS/FLUS. The cytopathologists re-interpreted the FNA samples and subclassified them into five subcategories: architectural atypia, cytologic atypia, cytologic and architectural atypia, and Hürthle cell AUS/FLUS, and atypia, which was not specified. Based on the suspicious ultrasound features, an appropriate ACR TI-RADS score was allocated to each nodule. Finally, the malignancy rate, surgical outcomes, and ACR TI-RADS scores were evaluated among Bethesda category III nodules.ResultsAmong the 70 evaluated nodules, 28 (40%) were subclassified as Hürthle cell AUS/FLUS, 22 (31.42%) as cytologic and architectural atypia, 8 (11.42%) as architectural atypia, 7 (10%) as cytologic atypia, and 5 (7.14%) as atypia which was not specified. The overall malignancy rate was 34.28%, and the architectural atypia and Hürthle cell nodules displayed lower malignancy compared to other groups (P-Value<0.05). Utilizing ACR TI-RADS scores showed no statistical significance between Bethesda III subcategorization and ACR TI-RADS scores. However, ACR TI-RADS can be a reliable predictor for Hürthle cell AUS/FLU nodules.ConclusionACR TI-RADS helps evaluate malignancy only in the Hürthle cell AUS/FLUS subcategory of AUS/FLUS. Besides, cytopathological reporting based on the suggested AUS/FLUS subclassification could help clinicians take appropriate measures to manage thyroid nodules.

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TIRADS ve bethesda sınıflandırmaları kullanılarak tiroid nodülünün ultrason ve sitolojik tanısının korelasyonu

YAKUPOĞLU

2023

Turkish Journal of Clinics and Laboratory

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Amaç: Tiroid nodülü olan bireylerin ilk değerlendirmesinde kullanılan iki tanı yöntemi TIRADS ve Bethesda sistemleri arasındaki uyumu değerlendirmektir. Gereç ve Yöntemler: Ocak 2020 ve Aralık 2022 yılları arasında tek bir girişimsel radyolog tarafından US kılavuzluğunda yapılan 414 tiroid nodüllü hastaya yapılan İİA biyopsileri retrosepektif olarak incelendi. Hastaların demografik bilgileri, nodüllerin boyutu, ekojenitesi ve kontur durumu, TIRADS ve BETHESDA skorları kaydedildi ve analiz edildi. Bulgular: Çalışma popülasyonunun ortalama yaşı 50.4 ± 14.2 idi ve çoğunluğu kadın hastalardı (%74.9). Hastaların ortalama nodül boyutu 18.36 ± 12.96 mm olarak ölçüldü. Tiroid nodülleri TRIADS kriterlerine göre sınıflandırıldığında 29 (%7) hastada TIRADS TR2, 147 (%35.5) hastada TIRADS TR3, 166 (%40.1) hastada TR4 ve 72 (%17.4) hastada TR5 idi. TIRADS 2, 3, 4 ve 5 sınıflarında Bethesda Class V ve Class VI olasılığı sırasıyla %0, %3.4, 31.3 ve %66.7 idi. TIRADS kategori 2'de Bethesda Sınıf II olasılığı %100 iken, TIRADS 3, 4 ve 5 sınıfları için sırasıyla %81.6, %34.9 ve %25 idi. Sonuçlar: Çalışmamız, tiroid nodülü İİAS'nin Bethesda Sınıflandırması ile TIRADS sınıflandırmasını kullanan tiroid ultrason raporlaması arasında oldukça iyi bir korelasyon olduğunu göstermektedir. İki bulgunun doğru yorumlanması, klinisyenin tiroid kanseri gösterme olasılığı düşük olan hastalarda gereksiz invaziv prosedür riskini azaltmasına yardımcı olurken, yüksek kanser riski taşıyan hastaların belirlenmesini kolaylaştırır.

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The relationship between ultrasound-based TIRADS and BETHESDA categories in patients undergoing thyroid biopsy

Cited by 3 publications

References 16 publications

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

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

Clinico-cytopathological subcategorization in thyroid nodules of atypia of undetermined significance/follicular lesion of undetermined significance using the TIRADS and Bethesda classifications

TIRADS ve bethesda sınıflandırmaları kullanılarak tiroid nodülünün ultrason ve sitolojik tanısının korelasyonu

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