Abstract
Simple SummaryThe use of risk-stratification systems for thyroid nodules based on ultrasound features may reduce the number of biopsies to be performed. The aim of our study was to assess the diagnostic performance of these systems in different age groups. We confirmed that all systems had a significant discriminative performance in all age groups. The system proposed by the American College of Radiology was the best performing one, but all risk-stratification systems could avoid a sizable number of biopsies when applied as rule-out tests (to exclude malignancy) in elderly patients.Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.
Highlights
Various published risk-stratification guidelines [1,2,3,4,5] provide recommendations for the evaluation of thyroid nodules based on the combination of nodule size and ultrasonographic (US) appearance [6], Cancers 2020, 12, 2458; doi:10.3390/cancers12092458 www.mdpi.com/journal/cancersCancers 2020, 12, 2458 with the aim of improving the standardization of thyroid ultrasound reporting and the identification of the small subset of nodules that warrant fine-needle aspiration biopsy (FNAB)
The aim of this study was to investigate whether the diagnostic performance of the five most widely used sonographic risk-stratification systems varied between age groups
While the prevalence of thyroid nodules increases with increasing age, the malignancy rate is reported to be lower [16]; the proper identification of the small number of lesions requiring clinical attention is of paramount importance in elderly patients
Summary
Cancers 2020, 12, 2458 with the aim of improving the standardization of thyroid ultrasound reporting and the identification of the small subset of nodules that warrant fine-needle aspiration biopsy (FNAB). The performance of these systems has been validated in retrospective [7,8,9,10] and prospective studies [11,12,13] and has been confirmed by a recent meta-analysis [14]. The decision of whether to perform a biopsy or monitor the nodule is based on the maximum nodule diameter, with a different threshold for each risk class. The ACR TIRADS has been found to outperform the other risk-stratification systems in its ability to decrease the number of biopsies while improving diagnostic accuracy [7,11,14]
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.
