Abstract
Background The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified. Methods The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings (n = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics (n = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS' sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based. Results The EU-TIRADS score influences decision of FNA in the 10–20 mm range. In such nodules (n = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively (p < 0.01). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) (p=0.02). Conclusions EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10–20 mm range escape surgery.
Highlights
Background. e classification of nodules by yroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management
Since 2017, EU-thyroid nodule image reporting and data systems (TIRADS) has been widely used for selection of thyroid nodules for Fine-needle aspiration cytology (FNA). e EU-TIRADS scores influence the decision of FNA in lesions with a maximum diameter between 10 and 20 mm [8]
E striking difference in the US-based FNA indication rate between follicular thyroid cancer (FTC) and non-FTC cancers was the consequence of the higher average EU-TIRADS scores in medullary thyroid cancer (MTC) (4.89) and papillary thyroid carcinomas (PTC) (4.80), compared to FTC (4.11). e substantially higher prevalence of suspicious US characteristics in non-FTC lesions is in accordance with the observations of others [13,14,15,16, 21, 22] (Table 4)
Summary
Background. e classification of nodules by yroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. E EUTIRADS score influences decision of FNA in the 10–20 mm range In such nodules (n 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively (p < 0.01). In the past 10 years, focus has changed and has mainly been driven by the principle of balancing diagnostic sensitivity and specificity and reducing the number of FNAs. e main tool for this change has been the consideration of suspicious ultrasound characteristics for the decision of performing FNA [3,4,5,6,7,8,9,10,11]. All guidelines published since 2006 link indications for cytology to suspicious US signs. ere are some differences between various thyroid nodule image reporting and data systems (TIRADS) [5,6,7,8,9] in what is considered suspicious and in the smallest thyroid
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