Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1,000 nodules (original) (raw)
Related papers
Tumor Biology, 2014
Purpose: To evaluate the diagnostic reliability of Thyroid Imaging Reporting and Data System (TI-RADS) classifications described by American College of Radiology (ACR) and Kwak et al. by calculating the risk of malignancy, to assess the role of TI-RADS in reducing fine-needle aspiration cytology (FNAC) of benign lesions. Material and methods: This was a prospective study during the period from December 2017 to August 2018. Thyroid nodules were classified using ACR TI-RADS and TI-RADS proposed by Kwak et al. The TI-RADS categorisations were compared to the final diagnosis obtained by cytopathological/histopathological analysis. The risk of malignancy for each category was calculated. Sensitivity, specificity, and positive and negative predictive values for individual suspicious ultrasound features were also assessed. Results: We evaluated a total of 127 thyroid nodules. The risk of malignancy was 0% in ACR TR1, 0% in ACR TR2, 6.9% in ACR TR3, 29.2% in ACR TR4, and 80% in ACR TR5 categories. The risk of malignancy for TI-RADS according to Kwak et al. were 0%, 0%, 21.5%, 32.4%, 100% for TI-RADS 2, 3, 4A, 4B, and 4C categories, respectively. Kwak TI-RADS 2 and 3 had higher sensitivity in predicting benignity compared to ACR TR1 and 2 (35.4% vs. 25.9%). Conclusions: We found TI-RADS classification to be a reliable, non-invasive, and practical method for assessing thyroid nodules in routine practice. TI-RADS can safely avert avoidable FNACs in a significant proportion of benign thyroid lesions.
Background: The thyroid imaging and reporting data system (TIRADS) has been routinely used to report thyroid nodules since its introduction in 2017. Similarly, the Bethesda system is a well-validated method used to report the cytopathology of thyroid lesions for over a decade. The aim of this study was to investigate the correlations between these two systems. Methods: This retrospective cohort study comprised patients who underwent ultrasound assessments of the thyroid gland followed by fine needle aspiration cytology (FNAC) of the thyroid nodules at a teaching hospital. The variables were categorised into ultrasound and cytological findings, and the outcomes measured from the two systems (validity of the system and risk of malignancy in each group of thyroid nodules) were correlated. Spearman’s correlation was used to determine the correlation, and the Kappa test was used to determine the agreement between the systems. Results: A total of 295 patients who fulfilled the inclusion c...
TURKISH JOURNAL OF MEDICAL SCIENCES
Introduction Ultrasound (US)-guided fine-needle aspiration (FNA) is considered as the gold standard, accurate, costeffective, and safe procedure in evaluation of thyroid nodules (1,2). However, FNA provides extremely specific and sensitive test for pathologic diagnosis, it has also some diagnostic limitations such as nondiagnostic (ND), inadequate, or unsatisfactory results. The estimated rate of malignancy in ND cytology has been reported as 1%-4% in the literature, and in this setting US-guided FNA repetition is recommended (3). The incidence of ND cytology has been reported in a wide range from 3% to 36.4% (2,4-7). A thyroid nodule with ND cytology generally causes diagnostic and therapeutic dilemma. Thyroid US is a widely-used, noninvasive method in the evaluation of thyroid nodules (8,9). High risk US features for malignancy are solidity, irregular borders, microcalcifications, marked hypoechogenicity, and more tall than wide shape (8,10,11). The thyroid imaging reporting and data system (TI-RADS) is useful in risk stratification of thyroid nodules by using the number of high risk US features (12). TI-RADS has been initially described in 2009 by two independent teams led by Horvath et al. and Park et al. (13,14). However, these systems are found as difficult to apply in daily practice. Recently, Kwak et al. presented a more convenient and simple system for TI-RADS classification based on analysis of suspicious US features (12). Thereafter, several different TI-RADS classifications have been proposed (15-17). Background/aim: We aimed to evaluate the utility of thyroid imaging reporting and data system (TI-RADS) in prediction of malignancy in thyroid nodules with persistent nondiagnostic (ND) cytology. Materials and methods: A total of 246 thyroid nodules which were surgically removed and had at least two fine-needle aspirations (FNAs) with ND cytology were included in this study. Ultrasonography features and TI-RADS scores were recorded. Results: Of 246 nodules, 218 (88.6%) had benign and 28 (11.4%) had malignant final histopathology. Frequencies of taller than wide shape, solidity, hypoechogenicity, microcalcifications, and presence of irregular borders were similar between benign and malignant nodules (P > 0.05). The number of nodules categorized as TI-RADS 3, 4a, 4b, and 4c were 12 (4.9%), 53 (21.5%), 104 (42.3%), and 77 (31.3%), respectively. There was not any nodule in TI-RADS 5 category. Malignancy rates of categories 3, 4a, 4b, and 4c were 0%, 13.2%, 9.6%, 14.3%, respectively. No significant differences were detected in TI-RADS categories between benign and malignant nodules (P > 0.05). Conclusion: In this study, we did not demonstrate any suspicious ultrasound (US) finding predictive for malignancy in thyroid nodules with persistent ND cytology and did not determine any difference between malignant and benign nodules regarding TI-RADS scores. Whereas, we found that thyroid nodules in 4a, 4b, and 4c TI-RADS categories had higher malignancy rates than those previously reported in ND cytology. We think that TI-RADS categories in thyroid nodules with persistent ND cytology can be helpful in treatment decision.
Annals of Pathology and Laboratory Medicine, 2018
Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid nodules by comparing the findings of thyroid ultrasound (US) using the thyroid image reporting and data system (TI-RADS) with the results of fine needle aspiration cytology (FNAC) that were reported according to the Bethesda system for reporting thyroid Cytopathology (TBSRTC), through matching the results of both maneuverswith the final postoperative (PO)pathology reports. Methods:The study included 100 patients suffering from thyroid swelling.Patients underwent ultrasound assessment using TI-RADS and FNAC biopsy using TBSRTCand then, all patients underwent thyroidectomy operation. Specimens sent to a laboratory for histological examination. The results of TI-RADS compared with Bethesda categories, and then both results were matched with the final histology reports. Data collected and statisticallyanalyzed. Results: The overall concordance rate between US TI-RADS and TBSRTC is 67.6%. (82% in benign cases, 70.9%, in indeterminate cases, 50% in malignant cases). The overall concordance rate of results of TI-RADS versus FNAC with the final PO pathological results for predicting malignancy were(75.4%, 81.8%)with a sensitivity of (76.9 %, 81.8%) and specificity of (91.3%,98%), positive predictive valueswere (PPV)(71.4%,90%), and negative predictive values were (NPV)(76.4%, 96%), respectively. Conclusion: TI-RADS and TBSRTC classification systems could be considered as feasible and effective diagnosticmodalities for predicting malignant lesions in patients had thyroid nodules. It's important for the clinicians to implement these diagnostic tests to improve their clinical performance and surgical outcomes.
European Journal of Endocrinology
Objective: The ultrasonographic scores EU TI-RADS and ACR TI-RADS were introduced to give the clinicians indications for fine needle aspiration cytology (FNAC). The predictive role of these scores was never evaluated and compared in a surgical series of patients. The aim of this study was to evaluate the ex post diagnostic accuracy of EU TI-RADS and ACR TI-RADS in a real-life series of thyroidectomized patients and to evaluate the ‘missing’ thyroid cancer following the operational indications of these scores. Design: Retrospective monocentric cohort study. Methods: In total, 255 patients (harboring 304 nodules) undergoing thyroidectomy for benign and malignant thyroid conditions were enrolled. The prevalence of thyroid malignancy for each class of ACR TI-RADS and EU TI-RADS, their diagnostic accuracy, the number of ‘unnecessary’ FNAC and the number of ‘missed’ cancers were evaluated. Results: ACR TI-RADS and EU TI-RADS score had similar and satisfactory accuracy values for predictin...
Head & Neck, 2013
Background. The Thyroid Imaging Reporting and Data System (TI-RADS) was proposed based on a scheme similar to Breast Imaging Reporting and Data System (BI-RADS) lexicon used in breast lesions. The purpose of this study was to evaluate its interobserver variability and accuracy. Methods. We included 498 nodules in 437 patients undergoing thyroidectomy. Two endocrine surgeons and 2 endocrinologists independently reviewed sonographic images.
Open Access Macedonian Journal of Medical Sciences, 2021
AIM: To reevaluate the correlations between ultrasound (US) features of thyroid nodules (THNs) and grades of Bethesda classification, to select correctly the patients who must undergo fine needle aspiration (FNAB). MATERIAL AND METHODS: In this study, we have included 260 cytologies of thyroid gland between the period of 2014–2018. The procedures are performed at radiology department of Hygeia Hospital. In our study are excluded the cases with a high risk of hemorrhage and the patients which did not accept the anesthetic procedure because of anxiety. The study includes only the first punctions with their respective Bethesda classification and not repeated FNAB cases. First using the z test, we compared the percentage occupied by the Bethesda categories that are indicative of surgery (BIV + BV + BVI) at US features that suspect malignancy (hypoechogenicity, microcalcifications, abnormal contours, central vascularization), with the percentage occupied by group (BIV + BV + BVI) at the ...
Thyroid Research, 2017
Background: Thyroid nodule is a common disorder of the thyroid. Despite their benign nature, they can be associated with multiple pathologic conditions, including thyroid cancer. Methods: This cross-sectional study determined the concordance of Ultrasound (TIRADS criteria) and Fine Needle Aspiration Biopsy (FNA-BETHESDA system) in the assessment of the nontoxic thyroid nodule. A total of 180 subjects 18 years old or older underwent the two diagnostic tests and their results were compared using kappa index. Results: Participants were mostly women, with average age of 57 years. The frequency of BETHESDA II was 65/180 versus 45/180 in TIRADS 2. In contrast, the highest frequency in category 4-IV was 62/180 for TIRADS 4 versus 41/ 180 for BETHESDA IV. The highest concordance was found among the category 2-II classification. The observed agreement was 87.2% with a linear weighted kappa of 0.69 (95% CI: 0.59-0.79). The heterogeneity analysis showed a trend towards a higher weighted kappa value in nodules ≥4 cm in males and individuals aged ≥50 years, with accelerated nodular growth, binding to adjacent structures, vocal folds paralysis, urban origin, and a history of head and neck radiation therapy. Conclusions: The TIRADS criteria has a good concordance with the Bethesda system. The ultrasound findings of benign pathology are aligned with the cytology results. The correct interpretation of the two findings helps the clinician to reduce the risk of unnecessary invasive procedures in patients with a low probability of presenting thyroid cancer, while facilitating the identification of patients at higher risk of cancer.
European Journal of Endocrinology, 2013
Objective: To evaluate prospectively the diagnostic accuracy of the thyroid imaging reporting and data system (TI-RADS) and its interobserver agreement and to estimate the reduction of indications of fineneedle aspiration biopsies (FNABs). Design: A prospective comparative study was designed. Methods: In 2 years, 4550 nodules in 3543 patients were prospectively scored using a flowchart and a six-point scale and then submitted to US-FNAB. Results were read according to the Bethesda system. Histopathological results were available for 263 cases after surgery. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value, and accuracy were calculated for the gray-scale score, elastography, and a combination of both methods. Interobserver agreement was calculated using the kappa statistic. The reduction in the number of FNABs was estimated. Results: When compared with cytopathological results, sensitivity, specificity, NPV, and accuracy were 95.7, 61, 99.7, and 62% for the TI-RADS gray-scale score; 74.2, 91.1, 98, and 90% for elastography; and 98.5, 44.7, 99.8, and 48.3% for a combination of both methods respectively. When compared with histopathological results, the sensitivity of the gray-scale score, elastography, and a combination of both methods were 93.2, 41.9, and 96.7% respectively. Interobserver agreement for the six-point scale and the recommendation for biopsy were substantial (k valueZ0.72 and 0.76 respectively). The reduction in the number of FNABs was estimated to be 33.8%. Conclusion: The TI-RADS score has high sensitivity and NPV for the diagnosis of thyroid carcinoma. A hard nodule should always be considered as suspicious for malignancy but elastography cannot be used alone. Combination of elastography with gray-scale can be used to improve sensitivity or specificity. Interobserver agreement and decrease in unnecessary biopsies are significant.