Ultrasound‐guided assessment of thyroid nodules based on the 2014 British Thyroid Association guidelines for the management of thyroid cancer – how we do it

Kanona, Hala; Virk, Jagdeep Singh; Offiah, Curtis; Stimpson, Paul

doi:10.1111/coa.12621

Cited by 8 publications

(9 citation statements)

References 3 publications

(3 reference statements)

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“…It was previously believed that nodule size upon presentation was a risk factor for malignancy, however, current literature supported by organizations, including the British Thyroid Association (BTA) and Korean Society of Thyroid Radiology (KSThR), state that size is not a reliable risk factor . This notion extends to suspicious subcentimeter nodules, which have reported at rates of 19% and with biopsy‐proven malignancy .…”

Section: Introductionmentioning

confidence: 99%

“…In order to properly stratify risk of malignancy, ultrasound imaging findings should be corroborated by relevant findings on clinical history and examination. Commonly cited clinical features increasing likelihood of cancer include familial history of differentiated thyroid cancer, multiple endocrine neoplasia type II, or medullary thyroid carcinoma, any previous radiation exposure, male sex, age under 20 or over 60 years, a firm or fixed nodule, and rapid nodular growth . Physical examination findings that suggest malignancy include vocal cord paralysis, regional lymphadenopathy, dysphonia, and fixation to surrounding tissue .…”

Section: Introductionmentioning

confidence: 99%

“…Commonly cited clinical features increasing likelihood of cancer include familial history of differentiated thyroid cancer, multiple endocrine neoplasia type II, or medullary thyroid carcinoma, any previous radiation exposure, male sex, age under 20 or over 60 years, a firm or fixed nodule, and rapid nodular growth. 5,[8][9][10][11][12] Physical examination findings that suggest malignancy include vocal cord paralysis, regional lymphadenopathy, dysphonia, and fixation to surrounding tissue. 5,9,12,13 Both the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) recommend serum thyroid-stimulating hormone as part of the initial workup.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of thyroid nodules: A practical algorithm and review of guidelines

Song

Dmytriw

et al. 2018

Head & Neck

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigation of thyroid nodules: A practical algorithm and review of guidelines

Song

Dmytriw

et al. 2018

Head & Neck

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“…2 As part of general guidelines on managing thyroid cancer, the British Thyroid Association (BTA, 2014) ultrasound (U-) classification of thyroid nodules was introduced, primarily to facilitate the decision of whether or not to proceed to FNAC. 2,14,15 Under this system, nodules are classified into categories U1 to U5, based on features including echogenicity, contour, halo, colloid artefact, calcification and vascularity ( Figure 1). Under this classification, U1 represents normal thyroid parenchyma, U2 a benign nodule, U3 an indeterminate/ equivocal nodule, U4 a suspicious nodule and U5 a malignant nodule.…”

Section: Introductionmentioning

confidence: 99%

British Thyroid Association 2014 classification ultrasound scoring of thyroid nodules in predicting malignancy: Diagnostic performance and inter-observer agreement

et al. 2019

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Objectives To assess the inter-observer agreement amongst five observers of differing levels of expertise in applying the British Thyroid Association (2014) guidelines for ultrasound scoring of thyroid nodules (BTA-U score) in the management of thyroid cancer, and to assess the U-score diagnostic performance in predicting malignancy. Method A total of 73 consecutive patients were included over a two-year period (July 2012 to July 2014), after referral to a tertiary head and neck oncology centre for ultrasound plus fine needle aspiration and cytology. Our five observers retrospectively and independently reviewed static ultrasound images on PACS and scored the thyroid nodules according to BTA-U classification. The observers were blinded to each other’s scoring, cytology and histology results. Either the Kappa-statistic or intra-class correlation was used to assess the level of inter-observer agreement, plus agreement between the radiological and cytological diagnoses. The diagnostic performance of U-scoring for predicting final histological diagnosis was assessed with sensitivity, specificity, positive and negative predictive values. Results A Kappa-value of 0.73 (95% CI: 0.68–0.77) confirmed substantial inter-observer agreement amongst the five observers. All 17 histology confirmed malignant nodules were correctly classified as potentially malignant by all observers. The sensitivity and negative predictive value of BTA-U score in detecting and predicting malignancy were 100%, whereas the specificity and positive predictive values were 34% and 32%, respectively. Conclusions There is good inter-observer agreement in using the BTA-U score amongst different observers at differing levels of expertise. Adhering to BTA-U scoring can potentially achieve 100% sensitivity in selecting malignant nodules for sampling.

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“…High-resolution ultrasound (US) examination is well-known for its high performance to detect and characterize thyroid nodules, and to stratify the risk of malignancy. For many years, there have been numerous different guidelines outlined by different organizations for the management of thyroid nodules detected on US (8,(14)(15)(16)(17)(18). In those updated guidelines, US-guided fine-needle aspiration (FNA) is generally recommended for thyroid nodules with a size of 1 cm or >1 cm even when US features are suspicious for malignancy.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic characteristics of medullary thyroid carcinoma according to nodule size: application of the Korean Thyroid Imaging Reporting and Data System and American Thyroid Association guidelines

Hahn

Shin

et al. 2020

Acta Radiol

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Background Few studies have categorized ultrasound (US) findings of various sized medullary thyroid carcinomas (MTCs) according to updated guidelines. Purpose To evaluate and compare the differences in US findings of MTC according to nodule size, using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American Thyroid Association (ATA) guidelines. Material and Methods The study included 119 patients with 129 MTC nodules, which were surgically confirmed at our institution between March 1999 and September 2017. Nodules were divided into large (≥1.0 cm) and small (<1.0 cm) groups. US images were analyzed according to the K-TIRADS and ATA guidelines. The differences in US characteristics between small and large nodules were compared using Fisher’s exact or Chi-square tests. Results Of 129 MTC nodules, 84 (65.1%) were large nodules and 45 (34.9%) were small nodules. According to the nodule size, small MTC nodules were classified more commonly as high suspicion by K-TIRADS and ATA (95.6% and 93.3%, respectively) ( P < 0.001), but presented neither cystic change, isoechogenicity, nor low suspicion category by K-TIRADS and ATA. In contrast, large MTC nodules showed more frequently cystic change (15.5%), isoechogenicity (16.7%), smooth margins (50%), or low or intermediate suspicion US features by K-TIRADS and ATA (59.6% and 36.0%, respectively) (all P values < 0.001). Conclusion Most small MTC nodules are classified as high suspicion on US, whereas large MTC nodules are diagnosed more frequently as low or intermediate suspicion by K-TIRADS and ATA.

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Ultrasound‐guided assessment of thyroid nodules based on the 2014 British Thyroid Association guidelines for the management of thyroid cancer – how we do it

Cited by 8 publications

References 3 publications

Investigation of thyroid nodules: A practical algorithm and review of guidelines

Investigation of thyroid nodules: A practical algorithm and review of guidelines

British Thyroid Association 2014 classification ultrasound scoring of thyroid nodules in predicting malignancy: Diagnostic performance and inter-observer agreement

Ultrasonographic characteristics of medullary thyroid carcinoma according to nodule size: application of the Korean Thyroid Imaging Reporting and Data System and American Thyroid Association guidelines

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