Thyroid imaging reporting and data system (TI‐RADS) of the American College of Radiology (ACR) for predicting malignancy in thyroid nodules &gt;1 cm with indeterminate cytology

Rocha, Tiara Grossi; Rosário, Pedro Weslley; Silva, Alexandre Lemos; Nunes, Maurício Buzelin; Calsolari, Maria Regina

doi:10.1002/dc.24119

Cited by 5 publications

(3 citation statements)

References 3 publications

(10 reference statements)

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“…Further sub-analysis suggests that the value of ThyroidPrint® testing is mainly in patients with intermediate-risk TI-RADS nodules, increasing the rate of active surveillance from 20% to 71%. However, this clinical benefit was not seen in patients with either low-risk or high-risk TI-RADS nodules, in which the rates of malignancy can be very low (5%) or very high (95%), respectively ( Tessler et al 2017 , Valderrabano & McIver 2017 , Rocha et al 2018 , 2019 ). Likewise, the presence of nuclear atypia in cytology increases the probability of malignancy up to 50%.…”

Section: Discussionmentioning

confidence: 94%

ThyroidPrint®: clinical utility for indeterminate thyroid cytology

Olmos,

Domínguez,

Vargas-Salas

et al. 2023

Endocrine-Related Cancer

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Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITN). ThyroidPrint® is a 10-gene classifier aimed to rule-out malignancy in ITN. Post-validation studies are necessary to determine the real-world clinical benefit of ThyroidPrint® in patients with ITN. A single center, prospective, non-interventional clinical utility study was performed, analyzing the impact of ThyroidPrint® in the physicians’ clinical decisions for ITN. Demographics, nodule characteristics, benign call rates (BCR) and surgical outcomes were measured. Histopathological data was collected from surgical biopsies of resected nodules. Of 1272 fine needle aspirations (FNA), 109 (8.6%) were Bethesda III and 135 (10.6%) Bethesda IV. Molecular testing was performed in 155 of 244 ITN (63.5%), of which 104 were classified as benign (BCR of 67.1%). After a median follow-up of 15 months, 103 of 104 (99.0%) patients with a benign ThyroidPrint® remained under surveillance and one patient underwent surgery which was a follicular adenoma. Surgery was performed in all 51 patients with a suspicious ThyroidPrint® result and in 56 patients that did not undergo testing, with a rate of malignancy of 70.6% and 32.1%, respectively. A higher BCR was observed in FLUS (87%) compared to AUS (58%) (p-value <0.05). False-positive cases included four benign follicular nodules, six follicular and four oncotytic adenomas. Our results show that, physicians chose active surveillance instead diagnostic surgery in all patients with a benign ThyroidPrint® result, reducing the need for diagnostic surgery in 67% in patients with preoperative diagnosis of ITN.

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Section: Discussionmentioning

confidence: 94%

ThyroidPrint®: clinical utility for indeterminate thyroid cytology

Olmos,

Domínguez,

Vargas-Salas

et al. 2023

Endocrine-Related Cancer

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“…Considering NIFTP/TUMP as benign, the RoM was 0% for the very low, 4.3% for the low, 22.4% for the intermediate, and 72% for the high-suspicion categories (Rocha et al 2018). Using TI-RADS ACR, the RoM was 0% for TI-RADS 2, 4% para TI-RADS 3, 22.4% for TIRADS 4, and 80% para TI-RADS 5 (Rocha et al 2019).…”

Section: R4mentioning

confidence: 97%

“…Considering NIFTP/TUMP as malignant, the RoM was 10% for the very low, 13% for the low, 42.8% for the intermediate, and 80% for the high-suspicion categories (Rocha et al 2018). Using TI-RADS ACR, the RoM was 0% for TI-RADS 2, 14.3% for TI-RADS 3, 38.8% for TI-RADS 4, and 90% for TI-RADS 5 (Rocha et al 2019). Considering NIFTP/TUMP as benign, the RoM was 0% for the very low, 4.3% for the low, 22.4% for the intermediate, and 72% for the high-suspicion categories (Rocha et al 2018).…”

Section: R4mentioning

confidence: 98%

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

Rosário

Rocha

Mourão

2021

Endocrine-Related Cancer

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In thyroid nodules (TN) submitted to fine-needle aspiration (FNA), Bethesda categories III and IV are considered “indeterminate” cytology. This result corresponds to 10-25% of all FNAs and the risk of malignancy (RoM) ranges from 10% to 30% for category III and from 15% to 40% for category IV. This review analyzed the practical applicability of accessible imaging method in the management of patients with cytologically indeterminate TN > 1 cm (ITN). When ITN are highly suspicious on ultrasonography (US), the RoM supports surgical indication even in the absence of additional tests. The same can be applied to ITN of intermediate suspicion but with elevated stiffness on elastography. Follow-up without additional tests is acceptable in the case of ITN with low-risk cytology and low-suspicion appearance on US and elastography (if obtained). In the case of ITN without highly suspicious US appearance, 123I scintigraphy may be obtained in patients with TSH < 1-1.5 mIU/L to rule out hyperfunctioning nodules before requesting diagnostic methods that are more expensive and less accessible. In addition, in ITN with not very suspicious US appearance, 18FDG-PET may be obtained. If this method does not reveal nodular uptake, the risk of the nodule corresponding to a macrocarcinoma is sufficiently low in order to allow follow-up. The positive predictive value of focal nodular uptake on 18FDG-PET depends on the pre-test RoM, cytological findings, and maximum SUV. There is currently no evidence for the use of computed tomography, magnetic resonance imaging or imaging using 99mTc-MIBI to define the nature of ITN.

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Molecular testing in thyroid cancer diagnosis and management

Sipos

Ringel

2023

Best Practice & Research Clinical Endocrinology & Metab

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Thyroid imaging reporting and data system (TI‐RADS) of the American College of Radiology (ACR) for predicting malignancy in thyroid nodules >1 cm with indeterminate cytology

Cited by 5 publications

References 3 publications

ThyroidPrint®: clinical utility for indeterminate thyroid cytology

ThyroidPrint®: clinical utility for indeterminate thyroid cytology

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

Molecular testing in thyroid cancer diagnosis and management

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