Abstract
Simple SummaryThe aim of this review is to provide the reader with a comprehensive overview of thyroid imaging and reporting data systems used for thyroid nodules, so as to understand how nodules are scored with all existing systems. Both ultrasound based risk stratification systems and indications for fine-needle aspirations are described. Systems are compared by analyzing their strengths and weaknesses. Studies show satisfactory sensitivities and specificities for the diagnosis of malignancy for all systems, and none of them have shown a real significant advantage over the others in terms of raw diagnostic value. Interobserver agreement is also very similar for all systems, fairly adequate to robust. Dimensional cut-offs for fine-needle aspiration are quite similar and all RSSs seem to reduce effectively the number of unnecessary FNAs. Merging all existing systems in a common international one is desirable.Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains.
Highlights
Risk stratification systems (RSSs) have two main aims
US-guided fine-needle aspiration biopsy (FNA) is recommended for subcapsular or paratracheal nodules, suspicious lymph nodes or suspicion of extrathyroidal spread, positive personal or family history of thyroid cancer, or coexistent suspicious clinical findings
FNA is recommended for TIRADS 4B or 4C or 5 nodules > 10 mm
Summary
Risk stratification systems (RSSs) have two main aims. The first one is to homogenize the results of thyroid ultrasound (US) reports, by using a quantitative cancer risk estimation approach, in order to facilitate communication between practitioners and with the patients. There again, the limitation of subjectivity for this decision is crucial for patients to hope to get homogenized care Some of these systems, but not all, have incorporated a lexicon and even more rarely a standardized report. All RSSs tend to base the whole stratification and decision making process solely on US criteria and nodular size, whereas obviously many other factors should, and are, integrated when accomplishing these tasks. Among these are patient’s age and sex; age of the disease; family history of thyroid cancer; personal history of cervical irradiation; clinical symptoms such as dysphonia, dysphagia, or dyspnea; nodular location; number of nodules; and presence of suspicious cervical lymph nodes. This review will describe present RSSs, their strengths, weaknesses, and pitfalls via a comprehensive analysis of the literature and make some suggestions for the future
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