Abstract
Objectives:To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary fine needle aspiration (FNA) rates.Methods:218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for FNA.Results:77 (35.3%) nodules were malignant. Deeming ultrasound Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilising BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001.Conclusion:BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering ultrasound Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA.Advances in knowledge:BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold-standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA.
Highlights
Thyroid nodules occur commonly with incidental nodules found in up to 67% of the population examined with high- resolution ultrasound.[1]
fine needle aspiration (FNA) is recommended for nodules graded U3 or above.[5]
Based on histopathology and ultrasound reports, laterality, nodule size and pathology outcome of the target nodules were recorded by Author 1 (LW) who has 2 years of general radiology experience
Summary
Thyroid nodules occur commonly with incidental nodules found in up to 67% of the population examined with high- resolution ultrasound.[1] Between 5 and 15% of nodules turn out to be malignant depending on age, sex, radiation exposure, family history and other factors.[2] Following introduction of neck ultrasound and image-guided FNA, there has been a worldwide increase in the incidence of thyroid cancer over the past four decades. The increase is accounted for by small papillary cancers. These small cancers, especially those
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