Abstract
BackgroundThyroid Imaging Reporting and Data System (TIRADS) was developed to improve patient management and cost-effectiveness by avoiding unnecessary fine needle aspiration biopsy (FNAB) in patients with thyroid nodules. However, its clinical use is still very limited. Strain elastography (SE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules.MethodsThe aim of the present study was to evaluate the interobserver agreement (IA) of TIRADS developed by Horvath et al. and SE. Three blinded observers independently scored stored images of TIRADS and SE in 114 thyroid nodules (114 patients). Cytology and/or histology was available for all benign (n = 99) and histology for all malignant nodules (n = 15).ResultsThe IA between the 3 observers was only fair for TIRADS categories 2–5 (Coheńs kappa = 0.27,p = 0.000001) and TIRADS categories 2/3 versus 4/5 (ck = 0.25,p = 0.0020). The IA was substantial for SE scores 1–4 (ck = 0.66,p<0.000001) and very good for SE scores 1/2 versus 3/4 (ck = 0.81,p<0.000001). 92–100% of patients with TIRADS-2 had benign lesions, while 28–42% with TIRADS-5 had malignant cytology/histology. The negative-predictive-value (NPV) was 92–100% for TIRADS using TIRADS-categories 4&5 and 96–98% for SE using score ES-3&4 for the diagnosis of malignancy, respectively. However, only 11–42% of nodules were in TIRADS-categories 2&3, as compared to 58–60% with ES-1&2.ConclusionsIA of TIRADS developed by Horvath et al. is only fair. TIRADS and SE have high NPV for excluding malignancy in the diagnostic work-up of thyroid nodules.
Highlights
In regions with inadequate iodine supply thyroid nodules are a common finding and are reported in one third of unselected adults [1]
Inclusion criteria were the presence of a thyroid nodule $5 mm, normal values of thyroid-stimulating hormone, and fine needle aspiration biopsy (FNAB) of this nodule performed within the last 6-months or FNAB and/or surgery planned at the time of ultrasound examination and performed within the study period
Stored images of B-mode, - and Doppler Ultrasound as well as Strain elastography (SE)-images were available for analysis from 114 nodules of 114 patients seen between Aug. 2010 to Mar. 2012
Summary
In regions with inadequate iodine supply thyroid nodules are a common finding and are reported in one third of unselected adults [1]. Ultrasound is an accurate method for the detection of thyroid nodules, but it has a low accuracy for the differentiation between benign and malignant thyroid nodules [2]. Fine-needleaspiration-biopsy (FNAB) is presently recommended as additional diagnostic method in the evaluation of thyroid nodules with a size of $10 mm in patients with normal thyroid stimulating hormone. FNAB is known to have a high specificity (60–98%) but varying sensitivity (54–90%) for the diagnosis of malignant thyroid nodules [7,8,9,10]. A relevant number of patients with the final diagnosis of benign thyroid nodules receive thyroid surgery more for diagnostic than for therapeutic purposes. Thyroid Imaging Reporting and Data System (TIRADS) was developed to improve patient management and cost-effectiveness by avoiding unnecessary fine needle aspiration biopsy (FNAB) in patients with thyroid nodules. Strain elastography (SE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
