Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy

Symonds, Christopher; Seal, Paula; Ghaznavi, Sana; Cheung, Winson Y.; Paschke, Ralf

doi:10.1007/s12020-018-1634-0

Cited by 21 publications

(33 citation statements)

References 26 publications

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“…Most physicians in the United States ( 28 ), Spain ( 29 ), and Italy ( 30 ) report using TIRADS or similar classifications when performing thyroid ultrasonography. However, most US reports in routine practice provide insufficient data for risk stratification ( 31 ). The optimal effectiveness of these systems in the real-world clinical practice also depends on the adoption of uniform terminology and accurate, nonambiguous definitions of the features being assessed.…”

Section: Thyroid Ultrasound and Sonographic Risk-stratification Systementioning

confidence: 99%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

171

140

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Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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Section: Thyroid Ultrasound and Sonographic Risk-stratification Systementioning

confidence: 99%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

171

140

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“…Es klingt zunächst trivial, aber eine solch zuverlässige Dignitätsbeurteilung kann nur erfolgen, wenn die etablierten sonografischen Malignitätskriterien im Sonografiebefund konsequent adressiert werden. Eine retrospektive Erhebung von Symonds et al offenbarte, dass von 1339 Ultraschallbefunden nur 13,7 % die Merkmale Binnenstruktur, Echogenität, Kalzifikationen, Randbegrenzung, Form und Größe enthielten und somit dem Leser des Befundes tatsächlich eine fundierte Risikoabschätzung erlaubt hätten [13].…”

Section: Warum Strukturiert Und Standardisiert Befunden?unclassified

TI-RADS und andere sonografische Klassifikationssysteme für Schilddrüsenknoten

2020

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Mehrere Arbeitsgruppen und Fachgesellschaften haben in den letzten Jahren Klassifikationssysteme für die sonografische Dignitätsbeurteilung von Schilddrüsenknoten vorgeschlagen, häufig unter dem Überbegriff „TI-RADS“. Diese Systeme zielen auf eine vereinheitlichte und möglichst umfassende Beurteilung von Knoten anhand definierter sonographischer Kriterien ab. Für verschiedene Befundkonstellationen leitet sich so eine jeweilige Malignomwahrscheinlichkeit ab, und die Rate an unnötigen Feinnadelpunktionen kann nachweislich reduziert werden. Es soll zudem verhindert werden, dass wichtige Einzelaspekte der Malignitätsabschätzung im Befund nicht adressiert werden. Der Beitrag stellt eine Übersicht der relevanten Klassifikationssysteme dar, erläutert die Definitionen der einzelnen sonographischen Kriterien unterstützt durch Bildbeispiele und fasst die aktuelle Evidenz zu den genannten Systemen zusammen.

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“…The follicles are filled with colloid that contains thyroid hormones produced from thyroglobulin and iodide, and the volume of colloid was found to be ORIGINAL PAPER three times larger than the volume of the epithelial cells, which suggests that the CT density is high in the normal thyroid as a result of the large amount of colloid present [35]. On the other hand, reduced density not only reflects the decrease of iodine concentration in the thyroid follicles but also represents a decrease in colloid content and an increase in follicular cells [36]. HT induces lymphocyte infiltration into the thyroid, which replace normal follicles and reduces the formation and reserve of thyroid hormones [37].…”

Section: Discussionmentioning

confidence: 99%

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

Luo

Huang

Zhou

et al. 2019

Endokrynologia Polska

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Introduction: The aim of the study is to investigate the usefulness of ultrasound combined with computed tomography (CT) for distinguishing between primary thyroid lymphoma (PTL) and Hashimoto's thyroiditis (HT). Material and methods: The investigation was conducted retrospectively in 80 patients from January 2000 to July 2018. All patients underwent pathological tests to be classified into one of two groups: PTL group and HT group. The cutoff value of CT density was determined using receiver-operating characteristic (ROC) curve analysis. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosis for thyroid by CT alone, ultrasound alone, and the combination of CT plus ultrasound were calculated. Results: Of the 80 study patients, 27 patients were PTL and 53 patients were HT. Mean CT density had a sensitivity of 90.6% and a specificity of 88.9% at a cutoff value of 53.5 HU, with area under the curve (AUC) 0.88. Ultrasound combined with CT had the highest specificity, accuracy, and PPV compared with CT alone and ultrasound alone (p value < 0.05). Conclusions: Features such as extremely hypoechogenicity, enhanced posterior echo, cervical lymphadenopathy in ultrasound image, and linear high-density strand signs, and very low density in CT imaging have high sensitivity and specificity in thyroid lymphoma. Therefore, ultrasound combined with CT may be useful for distinguishing between PTL and HT.

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Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy

Cited by 21 publications

References 26 publications

Contemporary Thyroid Nodule Evaluation and Management

Contemporary Thyroid Nodule Evaluation and Management

TI-RADS und andere sonografische Klassifikationssysteme für Schilddrüsenknoten

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

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