Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

Abstract

Objective Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine‐needle aspiration (FNA) biopsies in patients with thyroid nodules. Autonomously functioning thyroid nodules (AFTN) account for 5%‐10% of palpable lesions and are very rarely malignant. The present study was undertaken to investigate how RSSs classify AFTNs and whether RSSs are able to avoid unnecessary FNA biopsies in such cases. Methods Patients with AFTN who had undergone US, scintigraphy and thyroid function evaluation from December 2016 to December 2017 were selected. US images were retrospectively reviewed and AFTN reclassified according to AACE/ACE/AME, ACR‐TIRADS, ATA, BTA, EU‐TIRADS, K‐TIRADS and TIRADS. Risk class and indication for FNA were assessed. Results A number of 87 AFTNs from 85 consecutive patients were enrolled. A median diameter of 22 mm (range 10‐59) was found, with an ovoid isoechoic nodule being the most frequent US presentation. When AFTNs were reclassified according to US RSSs, the most common categories were low and intermediate risk. AFTNs were assessed as being at high risk/high suspicion/malignant in 1%‐9%, with good agreement among AACE/ACE/AME, ATA, EU‐TIRADS, K‐TIRADS and TIRADS. Remarkably, FNA was indicated in 27%‐90% of AFTNs. A statistically significant difference among the systems was found; 8% of cases were nonclassifiable by one or more US RSS. Conclusions Ultrasound RSSs prompt inappropriate FNA in a significant number of patients with AFTN.

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

“…Many authors even recommend this method in euthyroid individuals with TSH in the lower half of the reference range, especially in iodine-deficient regions (Gharib et al 2016, Russ et al 2017, Giovanella et al 2019. With this management, it is believed that part of the nodules with an indication for FNA based on US may not require this procedure because scintigraphy reveals hyperuptake (Schenke et al 2019, Castellana et al 2020, Noto et al 2020. Finally, the indication that interests us here are euthyroid patients with nodules > 1 cm whose cytology was indeterminate.…”

Dati evidence-based sulla affidabilità dei sistemi ecografici per la stratificazione del rischio di malignità del nodulo tiroideo (TIRADS)

“…Fig. 1 Due casi paradigmatici di pazienti con nodulo autonomo [15] Dati più sparsi sono disponibili relativamente al carcinoma follicolare, midollare e anaplastico. In particolare, in una casistica di 45 pazienti affetti da carcinoma follicolare della tiroide è stata dimostrata una buona performance dei più comuni TIRADS nel porre indicazione all'agoaspirato (tra il 69 e il 100% dei casi, a seconda del TIRADS).…”

Die „Standard“-Schilddrüsenszintigrafie – ist sie noch zeitgemäß?

“…Interessanterweise weisen autonome Knoten zu einem hohen Prozentsatz Ultraschallcharakteristika auf, die zu einem höheren Risiko-Score führen: in unserer kürzlich publizierten deutschen Studie an 615 szintigrafisch mehranreichernden Knoten [28] stellte sich die Hälfte echoarm dar; insgesamt 57,6 % der untersuchten autonomen Knoten waren in der TIRADS-Kategorie 4B oder höher nach Kwak et al 2011 [29] angesiedelt, wären also (ohne Kenntnis des Szintigrafiebefundes) mit der − in diesen Fällen fast immer unnötigen − Empfehlung zur zytologischen Dignitätsabklärung versehen worden. Zu ähnlichen Ergebnissen kamen Castellana et al 2020 [30], die unter Zugrundelegung diverser Scoring-Systeme (AACE/ACE/AME, ATA, EU-TIRADS, K-TIRADS und TIRADS) analysierten, dass bei autonomen Knoten in 27 -90 % der Fälle unnötigerweise eine Feinnadelpunktion erfolgen müsste.…”