Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm).

Simone Schenke,Michael C Kreissl,Michael Zimny,Rigobert Klett,Rainer Görges,Philipp Seifert

doi:10.3390/jcm9010236

Abstract

Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.

Highlights

Due to the widespread use of ultrasound as well as the increasing number of imaging studies performed for reasons other than planned assessment of the thyroid gland, incidental thyroid nodules (TNs) ≤ 10 mm are common findings [1,2,3,4,5]
Lymph node metastases (LNMs) were found in 20% of the PTC and there were no LNMs in the two cases of MTC (Table 1)
The authors focused on the low malignancy rates of “low-suspicion” Thyroid Imaging Reporting and Data Systems (TIRADS) classes. These results indicate that the use of TIRADS could prevent the overdiagnosis and overtreatment of “low-risk” TNs [22]

Summary

Introduction

Due to the widespread use of ultrasound as well as the increasing number of imaging studies performed for reasons other than planned assessment of the thyroid gland (i.e., computed tomography of the chest or cervical spine, magnetic resonance imaging of the cervical spine, and whole-body positron emission tomography), incidental thyroid nodules (TNs) ≤ 10 mm are common findings [1,2,3,4,5]. A number of standardized reporting systems (e.g., ACR TI-RADS, EU-TIRADS, Korean-TIRADS) have been proposed. These reporting systems include recommendations for the appropriate further diagnostic steps [7,8,9]. The ACR TI-RADS recommends a fine-needle-aspiration biopsy (FNA) for highly suspicious TNs if the diameter is 10 mm or larger. The EU-TIRADS, published in 2017, recommends shared decision-making (FNA vs active surveillance) with the patient when subcentimetric TNs with highly suspicious ultrasound features without abnormal lymph nodes are detected [8]. The purpose of this study was to compare three different variants of TIRADS (Kwak-, ACR, and EU-TIRADS) in terms of the risk stratification of small TNs (≤10 mm) in the routine clinical practice

Objectives

Results

Conclusion