Assessment Of Thyroid Nodules Research Articles

Accuracy of Thyroid Imaging Reporting and Data System in Evaluation of Thyroid Neoplasm

Background: Several US Thyroid Imaging Reporting and Data Systems (TIRADS) have been proposed for risk assessment of thyroid nodules. The nodules are usually divided into variant categories based on TIRADS and are then guided to Fine Needle Aspiration (FNA) Biopsy or follow-up, according to the risk of malignancy. Objective: To assess the specificity, sensitivity and accuracy of TIRADS in diagnosis of thyroid neoplasm Patients and Methods: This study included 60 patients presented to the General Surgery and Endocrine Surgery Unite Outpatient Clinic at Mansoura University Hospitals with thyroid disorders. The study was conducted during the period between 1 November 2018 and the end of March 2020. All patients were radiologically evaluated using neck ultrasound with TIRADS classification. Fine needle aspiration was performed and the results of both were compared to the postoperative pathology reports. Results: the current study evaluated the accuracy of TIRADS (TIRADS 3,4a and 4b) compared to (TIRADS 4c and 5) with sensitivity 83.3%, specificity 92.9%, PPV 83.3%, NPV 92.9% and accuracy 90.0%. Conclusion: TIRADS scoring system is of great value in the diagnosis of simple nodular goiter as it gives a degree of accuracy more than 90% compared to FNAC were the degree of accuracy was 78.3%.

Accuracy of Thyroid Imaging Reporting and Data System in Evaluation of Thyroid Neoplasm

Background: Several US Thyroid Imaging Reporting and Data Systems (TIRADS) have been proposed for risk assessment of thyroid nodules. The nodules are usually divided into variant categories based on TIRADS and are then guided to Fine Needle Aspiration (FNA) Biopsy or follow-up, according to the risk of malignancy. Objective: To assess the specificity, sensitivity and accuracy of TIRADS in diagnosis of thyroid neoplasm Patients and Methods: This study included 60 patients presented to the General Surgery and Endocrine Surgery Unite Outpatient Clinic at Mansoura University Hospitals with thyroid disorders. The study was conducted during the period between 1 November 2018 and the end of March 2020. All patients were radiologically evaluated using neck ultrasound with TIRADS classification. Fine needle aspiration was performed and the results of both were compared to the postoperative pathology reports. Results: the current study evaluated the accuracy of TIRADS (TIRADS 3,4a and 4b) compared to (TIRADS 4c and 5) with sensitivity 83.3%, specificity 92.9%, PPV 83.3%, NPV 92.9% and accuracy 90.0%. Conclusion: TIRADS scoring system is of great value in the diagnosis of simple nodular goiter as it gives a degree of accuracy more than 90% compared to FNAC were the degree of accuracy was 78.3%.

Efficacy of Ultrasound Intrinsic Compression Strain Elastography in Prediction of Malignancy in Thyroid Nodules with Fine Needle Aspiration Cytology Correlation

Background: Different diagnostic modalities are used to evaluate and diagnose efficiently thyroid nodules. These include Clinical Examinations, Thyroid Function Test (TFT), Scintiscan, Ultrasonography (USG), Fine Needle Aspiration Cytology (FNAC), and Histopathological examination. However, clinical assessment, TFT and USG have been poor parameters for assessing thyroid nodules. The objective is to this study was aimed to evaluate the efficacy of Ultrasound Elastography for the prediction of malignancy in thyroid nodule. Subjects and Methods:After obtaining written informed consent, demographic data such as age, sex and clinical features like, swelling, mode of onset, difficulty in swallowing, difficulty in breathing, hoarseness of voice obtained through an interview and recorded on predesigned and pretested proforma (Annexure II). Further these patients were subjected Grayscale Ultrasound, Ultrasound Elastography and FNAC. Results: Malignant lesions were noted in 19 patients on FNAC. Among them, 16 (84.21%) patients had malignant lesions while 3 (15.79%) patients had benign lesions based on combined USE and ECI criteria. This difference was statistically significant (p<0.001). The sensitivity of combined USE and ECI criteria in the diagnosis of malignant lesions was 84.21% with Specificity of 81.69%, PPV 55.17% and NPV 95.08%. Conclusion: Based on the findings of this study it may be concluded that, USE as determined by the Ragos criteria, TI RADS score are highly associated with malignant thyroid lesions and useful in differentiating the malignant thyroid lesions from benign ones.

Reliability of Thyroid Imaging Reporting and Data System (TI-RADS), and Ultrasonographic Classification of the American Thyroid Association (ATA) in Differentiating Benign from Malignant Thyroid Nodules

Abstract Background: Thyroid nodules are a frequent finding on necksonography. Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Thyroid nodules are vastly prevalent whereas thyroid cancer is a relatively rare entity. Aim of Study: The aim of this study is to evaluate the risk stratification system used by the American College of Radi-ology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Patients and Methods: Across sectional study, the study setting was conducted at Ain Shams University Hospitals, from January 2020 till July 2020. This study was performed on random sample of 30 patients have thyroid nodules were included in this study. Results: In this study was found that 66.7% of the malig-nant nodules had smooth margins and 33.3% of the malignant nodules had lobulated or irregular nodules. Also, it was found that of the 31 benign nodules included in our study, 20 nodules (64.5%) had smooth margins and 11 nodules (35.5%) had ill defined margins; showing significant increase in benign group than malignant group. In this study, the results to were com-parable those reported in other studies, 11.1% of the malignant nodules had no echogenic foci, 11.1% of the malignant nodules had macrocalcifications, 11.1% of the malignant nodules had peripheral calcifications, 66.7% of the malignant nodules had punctate echogenic foci. Nodules with no echogenic foci had a statistically significant increase in benign group than malig-nant group. Conclusion: The ACR TI-RADS scoring system is a simple and practical method for assessing thyroid nodules and has shown an excellent diagnostic accuracy for the diag-nosis of malignant thyroid nodules in the present study.

The Role of Ultrasound in the Diagnosis of Malignant Thyroid Nodules

Background: Thyroid nodules are very common in clinical practice. Although most of thyroid nodules are benign, it is crucial to checkout which nodules are more likely to be malignant. Ultrasound is a major diagnostic tool for screening and evaluating thyroid diseases because it is safe, non-invasive, non-radioactive and effective.Objective: The aim is to identify the role of ultrasound in assessing thyroid nodules and to review various ultrasound criteria predicting malignancy.Patients and methods: A case series study conducted during the period from January 2015 to February 2016 at the First Surgical Unit, Department of Surgery, Baghdad Teaching Hospital by a team of surgeons. One hundred eighty Patients who underwent surgical intervention for nodular thyroid disease were included in the study. The ultrasound features of these patients were analyzed with respect to the number of nodules (solitary or multiple), size, echogenicity, consistency, the presence of calcification, border definition, vascular pattern and whether there was lymphadenopathy and / or local invasion to adjacent structures. The final diagnosis was confirmed by histopathological examination after surgery. The ultrasound features of thyroid nodules were studied for their correlation with benign and malignant lesions.Results: Among 180 patients with nodular thyroid disease, thyroid malignancy was found in 22 (12.2%) patients. Ultrasound features of thyroid nodules included significant echogenicity, consistency, calcification, border definition, vascular pattern and the presence of local invasion. Ultrasound features suggesting malignant nodules are solid and hypoechoic nodules, ill-defined borders, nodules with local invasion to adjacent structures, the presence of microcalcification and nodules that show increased vascularity on doppler study.Conclusion: Ultrasound is useful in evaluating nodular thyroid disease and is valuable for identifying many malignant and potentially malignant nodules. Despite that, no single ultrasound feature is reliable in making the diagnosis of thyroid malignancy, combining ultrasound suggestive criteria could aid in predicting malignant nature of a given nodule.

Variation of Shear Wave Elastography With Preload in the Thyroid: Quantitative Validation.

Thyroid shear wave elastography (SWE) has been shown to have advantages compared to biopsy or other imaging modalities in the evaluation of thyroid nodules. However, studies show variability in its assessment. The objective of this study was to evaluate whether stiffness measurements of the normal thyroid, as estimated by SWE, varied due to preload force or the pressure applied between the transducer and the patient. In this study, a measurement system was attached to the ultrasound transducer to measure the applied load. Shear wave elastographic measurements were obtained from the left lobe of the thyroid at applied transducer forces between 2 and 10 N. A linear mixed-effects model was constructed to quantify the association between the preload force and stiffness while accounting for correlations between repeated measurements within each participant. The preload force effect on elasticity was modeled by both linear and quadratic terms to account for a possible nonlinear association between these variables. Nineteen healthy volunteers without known thyroid disease participated in the study. The participants had a mean age ± SD of 36 ± 8 years; 74% were female; 74% had a normal body mass index; and 95% were white non-Hispanic/Latino. The estimated elastographic value at a 2-N preload force was 16.7 kPa (95% confidence interval, 14.1-19.3 kPa), whereas the value at 10 N was 29.9 kPa (95% confidence interval, 24.9-34.9 kPa). The preload force was significantly and nonlinearly associated with SWE estimates of thyroid stiffness. Quantitative standardization of preload forces in the assessment of thyroid nodules using elastography is an integral factor for improving the accuracy of thyroid nodule evaluation.

Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students.

In conventional thyroid diagnostics, the topographical correlation between thyroid nodules (TN) depicted on ultrasound (US) in axial or sagittal orientation and coronally displayed scintigraphy images can be challenging. Sensor-navigated I-124-PET/US fusion imaging has been introduced as a problem-solving tool for ambiguous cases. The purpose of this study was to investigate the results of multiple unexperienced medical students (MS) versus multiple nuclear medicine physicians (MD) regarding the overvalue of I-124-PET/US in comparison to conventional diagnostics (CD) for the functional assessment of TN. Methods: Out of clinical routine, cases with ambiguous findings on CD were selected for I-124-PET/US fusion imaging. Sixty-eight digital patient case files (PCF) of 34 patients (CDonly and CD+PET/US PCF) comprising 66 TN were provided to be retrospectively evaluated by 70 MD and 70 MS, respectively. A total of 2174 ratings (32.9 per TN) were carried out: 555 ratings (8.4 per TN) for CDonly and 532 ratings (8.1 per TN) for CD+PET/US by each MD and MS. Results: Functional assessment revealed 8.5%/11.7% (n.s.) (16.4%/25.8% (p = 0.0002)), 41.8%/28.5% (p < 0.0001) (23.9%/17.9% (p = 0.0193)), 36.0%/30.5% (n.s.) (57.3%/53.9% (n.s.)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) hyperfunctioning, indifferent, hypofunctioning, and not rateable TNs for CDonly (CD+PET/US) and MD/MS, respectively. The respective rating confidence was indicated as absolute certain, quite certain, equivocal, uncertain, and not rateable in 11.7/3.4% (p < 0.0001) (44.9%/38.9% (p = 0.0541), 51.9%/26.7% (p < 0.0001) (46.2%/41.5% (n.s.)), 21.6%/29.0% (p = 0.0051) (6.2%/14.8% (p < 0.0001)), 1.1%/11.5% (p < 0.0001) (0.2%/2.3% (p = 0.0032)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) by MD/MS, respectively. There was a significant difference in the diversity of the observers’ functional assessment of TN (MD 0.84 vs. MS 1.02, p = 0.0006) and the respective confidence in functional assessment (MD 0.93 vs. MS 1.16, p < 0.0001) between MD and MS on CDonly, whereas CD+PET/US revealed weaker differences for both groups (MD 0.48 vs. MS 0.47, p = 0.57; and MD 0.66 vs. MS 0.83, p = 0.0437). With the additional application of I-124-PET/US, the rating diversity of both MD and MS markedly tends towards more consistency (p < 0.0001 in each case). Conclusion: The additional application of sensor-navigated I-124-PET/US fusion imaging significantly influenced the functional assessment of TN positively, especially for unexperienced observers.

Nodular goiter

The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only afew of these nodules are malignant or symptomatic. Even today athorough medical history, detailed examination of the neck region, aqualified US of the thyroid gland, a99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is astandardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with ahigh risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools.

Appropriateness of ultrasound imaging for thyroid pathology, the standard of radiology reporting on thyroid nodules and the detection rates of thyroid malignancy: a tertiary centre retrospective audit.

The incidence of thyroid cancer is increasing worldwide without a simultaneous rise in mortality. It is thought that the incidence of non-clinically significant thyroid cancers are on the rise as a result of more sensitive diagnostic imaging. To determine the number of inappropriate requests for thyroid ultrasound (US), the quality of radiology reporting for thyroid nodules based on accepted guidelines and the resultant number of thyroid cancers identified because of these investigations. Electronic medical records of patients who underwent thyroid US imaging and thereafter referred to the Endocrine Department at Gold Coast University Hospital, Queensland, between July 2014 and July 2017 were reviewed. Data for 251 patients who had thyroid US were analysed and the final 201 patients who were found to have thyroid nodules were evaluated using descriptive statistics. Indications for thyroid US imaging among referring clinicians were assessed and we compared both clinical management and radiology reporting practices of thyroid nodules to the published 2009 and 2015 American Thyroid Association (ATA) guidelines. There were 50.2% of patients with initial thyroid US imaging deemed outside of expert recommendations where 42% of these patients required further surveillance imaging and 25.4% required fine needle aspiration of their thyroid nodules. A definite recommendation whether to evaluate thyroid nodules further was provided in 44.8% of radiology reports. There were no radiology reports that described thyroid nodules findings based on patterns as recommended by the 2015 ATA guidelines. Two cases of thyroid cancer were detected including one patient with prior history of thyroid cancer and a second patient with hypothyroidism. Routine use of US thyroid imaging outside expert recommendation is common. There is lack of standardised reporting when assessing thyroid nodules on US. Limiting the initial use of US in cases of palpable neck lumps and the use of systematic reporting according to the 2017 guidelines published by the American College of Radiology Thyroid Imaging Reporting and Data System may reduce unnecessary investigations for thyroid nodules in the future.

Determining whether surgeons perform thyroid fine-needle aspiration as well as radiologists: an analysis of the adequacy and efficiency of ultrasound-guided fine-needle aspiration performed by newly trained head and neck surgeons and radiologists.

Ultrasound-guided fine-needle aspiration (FNA) cytology is a crucial diagnostic technique used to assess thyroid nodules. In the past, ultrasound-guided FNA was performed mainly by radiologists. However, many surgeons are increasingly being trained for this procedure now. In this study, we aimed to compare the adequacy and efficiency of ultrasound-guided FNA performed by newly trained head and neck surgeons with experienced radiologists in a single institution. We also assessed the malignancy rates in nondiagnostic nodules and the differences between benign and malignant nodules. This is a retrospective study. The data from patients who underwent ultrasound-guided FNA performed by surgeons or radiologists in two consecutive years were collected. Medical records, cytology results, and surgical pathology results were analyzed. During the study period, a total of 2,405 ultrasound-guided FNAs were performed on 2,163 patients. The head and neck surgeons and radiologists performed 1,132 and 1,273 ultrasound-guided FNA procedures, respectively. The nondiagnostic rate was 14.49% for surgeons and 15.40% for radiologists (P=0.533). There were no differences in patient age, gender, nodule size, and other sonographic characteristics between the groups of patients who were treated by radiologists versus surgeons. The median waiting time from biopsy appointment to performing ultrasound-guided FNA was 0 days for head and neck surgeons, and 6 days for radiologists (P<0.001). Of the 40 patients who had a repeat FNA or surgery, 19 (47.50%) had a malignancy. Preoperative information about age, gender, operator, and characteristics of nodules did not predict the outcome of nodules with Bethesda category I. The adequacy of ultrasound-guided FNAs performed by head and neck surgeons is similar to that of skilled radiologists, while surgeons are more efficient than radiologists. Nondiagnostic FNA reports should not be considered benign, and repeat FNA or selective surgical treatment is recommended.

Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis

PurposeTo investigate the interobserver agreement of different thyroid imaging report and data system (TI-RADS) and ultrasound (US) features. MethodsTwo researchers independently searched PubMed, Embase and the Web of Science for relevant studies published between October 1972 and December 2018. Studies investigating interobserver agreement between different radiologists were included. The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score tools were applied to assess the quality of the studies. The data for the inter-agreements of TI-RADS categories and ultrasound features were extracted, and combined with STATA 12.0 (StataCorp, College Station, TX) was used. ResultsSeven studies including 927 patients were eligible for this meta-analysis. There was a moderate variability in the TI-RADS categories among radiologists (0.54; 95% CI: 0.49−0.58). Regarding the US features, the reliability of composition (0.61; 95% CI: 0.55−0.66) and calcification (0.71; 95% CI: 0.65−0.77) was good, the reliability of echogenicity (0.58; 95% CI: 0.51−0.64), shape (0.53; 95% CI: 0.45−0.62), margin (0.40; 95% CI: 0.32−0.48) and echogenic foci (0.43; 95% CI: 0.32−0.54) was moderate. Subgroup analyses showed that experience/training, the number of observers and the number of patients were the main factors influencing the variability. ConclusionsThe interobserver agreement for the TI-RADS categories was moderate. There remains potential for improvement, especially in terms of the echogenicity, shape, margin and echogenic foci, the precision of the description and the targeted training needed.

Quantitative Assessment of Thyroid Nodules Using Dual-Energy Computed Tomography: Iodine Concentration Measurement and Multiparametric Texture Analysis for Differentiating between Malignant and Benign Lesions.

Results The 34 nodules comprised 14 benign nodules and 20 malignant nodules. Iodine content and Hounsfield unit curve slopes did not differ significantly between benign and malignant thyroid nodules (P = 0.480–0.670). However, significant differences in the texture features of monochromatic images were observed between benign and malignant nodules: histogram mean and median, co-occurrence matrix contrast, gray-level gradient matrix (GLGM) skewness, and mean gradients and variance of gradients for GLGM at 80 keV (P = 0.014–0.044). The highest AUC was 0.77, for the histogram mean and median of images acquired at 80 keV. Conclusions Texture features extracted from monochromatic images using DECT, specifically acquired at high keV, may be a promising diagnostic approach for thyroid nodules. A further large study for incidental thyroid nodules using DECT texture analysis is required to validate our results.

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Thyroid Image Reporting and Data System Categorization: Effectiveness in Pediatric Thyroid Nodule Assessment.

Ultrasonography (US) is the main imaging method to assess thyroid nodules. In the pediatric population, thyroid nodules are less prevalently seen than those in adults. However, approximately 25% of the nodules can be malignant. Validation of Thyroid Image Reporting and Data System (TI-RADS) classification has been mostly tested in adults, and information on pediatric cases is limited. In the current study, we aim to define the diagnostic power of the TI-RADS risk stratification method in pediatric thyroid nodules.The study population consists of 68 nodules of 64 patients (20 malignant, 48 benign). We have included patients at least 18 years and with a pathological diagnosis. The researchers evaluated the US images of the patients, if available. If US images cannot be found, US reports of the patients were evaluated to define TI-RADS points and category.Mean age of the population is 15.15 ± 2.66 years. There were 10 (17.7%) male patients and 58 (85.3%) female patients. Median nodule size was 8 mm. Final diagnosis was benign in 48 nodules (70.6%) and malignant in 20 nodules (29.4%). There were 5 follicular carcinoma cases and 15 papillary carcinoma cases. The area under the curve estimate was 0.89 (95% confidence interval, 0.80-0.98), and the area under the curve value confirmed the diagnostic efficacy of TI-RADS categorization in pediatric thyroid nodules. A TI-RADS category of 4 or 5 seemed to be a good cutoff point to predict malignancy.To conclude, TI-RADS categorization can be effectively used to assess pediatric thyroid nodules. Nodules with TI-RADS categories of 4 and 5 have the greatest risk of malignancy, and they should be evaluated pathologically.

Efficacy of dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin scintigraphy for the assessment of thyroid nodules.

Radioisotope methods have shown to be useful in the non-invasive diagnosis of thyroid nodules over the past years. The present prospective study aims to evaluate the efficacy of gamma imaging using single and dual tracer using Tc-99m pertechnetate and Tc-99m tetrofosmin for evaluation and management of thyroid nodules. Dynamic (perfusion) imaging was performed after injecting 148-185MBq (4-5mCi) of Tc-99m pertechnetate followed by static imaging. A second, dynamic (perfusion) imaging study within same week was performed with 296-370MBq (8-10mCi) of Tc-99m tetrofosmin on same group of patients followed by early and delayed images. Results of radionuclide perfusion scan from both studies were compared qualitatively with postsurgical histopathology or fine needle aspiration cytology (FNAC). Total 65 nodules in 50 patients were included in the study. With single tracer, the specificity and accuracy of Tc-99m pertechnetate was 23% and 45% and for Tc-99m tetrofosmin scan was 40% and 49%. When dual tracers were evaluated for the same group of patients, the specificity was 56% and accuracy was 55%. Dual Tracer technique with Tc-99m pertechnetate and Tc-99m tetrofosmin could be helpful in selecting nodules need surgical intervention. This technique can be used for convenient and rapid diagnostic evaluation of thyroid nodules non-invasively. We suggest a combination of fine needle aspiration biopsy and dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin as a routine diagnostic approach to thyroid nodules.

Clinical validation of S-DetectTM mode in semi-automated ultrasound classification of thyroid lesions in surgical office.

In recent years well-recognized scientific societies introduced guidelines for ultrasound (US) malignancy risk stratification of thyroid nodules. These guidelines categorize the risk of malignancy in relation to a combination of several US features. Based on these US image lexicons an US-based computer-aided diagnosis (CAD) systems were developed. Nevertheless, their clinical utility has not been evaluated in any study of surgeon-performed office US of the thyroid. Hence, the aim of this pilot study was to validate s-DetectTM mode in semi-automated US classification of thyroid lesions during surgeon-performed office US. This is a prospective study of 50 patients who underwent surgeon-performed thyroid US (basic US skills without CAD vs. with CAD vs. expert US skills without CAD) in the out-patient office as part of the preoperative workup. The real-time CAD system software using artificial intelligence (S-DetectTM for Thyroid; Samsung Medison Co.) was integrated into the RS85 US system. Primary outcome was CAD system added-value to the surgeon-performed office US evaluation. Secondary outcomes were: diagnostic accuracy of CAD system, intra and interobserver variability in the US assessment of thyroid nodules. Surgical pathology report was used to validate the pre-surgical diagnosis. CAD system added-value to thyroid assessment by a surgeon with basic US skills was equal to 6% (overall accuracy of 82% for evaluation with CAD vs. 76% for evaluation without CAD system; P<0.001), and final diagnosis was different than predicted by US assessment in 3 patients (1 more true-positive and 2 more true-negative results). However, CAD system was inferior to thyroid assessment by a surgeon with expert US skills in 6 patients who had false-positive results (P<0.001). The sensitivity and negative predictive value of CAD system for US classification of thyroid lesions were similar as surgeon with expert US skills whereas specificity and positive predictive value were significantly inferior but markedly better than judgement of a surgeon with basic US skills alone.

Diagnostic performance of the American Thyroid Association ultrasound risk assessment of thyroid nodules in endocrinology (the ETIEN 3 study)

IntroductionNo study has been published to date in Spain about the value of the American Thyroid Association (ATA) ultrasound risk assessment of thyroid nodules applied by endocrinologists. ObjectivesTo assess the diagnostic performance of ATA thyroid nodule risk classification applied by endocrinologists with respect to histological results. MethodsA retrospective, observational study of 317 patients (mean age, 51.7±13.7 years; 83.3% women) with thyroid nodules (maximum diameter: 3.2±1.4cm) who underwent US-guided FNA in endocrinology between October 2015 and December 2018, were classified based on the ATA ultrasound risk assessment. Surgery was performed in all of them. Quality criteria of the ultrasound classification were assessed as compared to histological results. ResultsOverall, 61.2% of nodules assessed were classified as benign (n=3) and very low (n=60) or low suspicion (n=131), 11.7% as intermediate suspicion (n=37), and 27.1% as high suspicion (n=86). Benign nodular disease was found in 260 patients, and thyroid cancer in 57 patients. There were 14 incidental papillary microcarcinomas. Classification of thyroid nodules as high suspicion showed a high diagnostic performance to identify malignant nodules (87.7% sensitivity, 86.2% specificity, negative predictive value 97.0%), improving sensitivity (93.0%) and reducing specificity (73.1%) when considering high and intermediate suspicion nodules as a risk for thyroid cancer. ConclusionsApplication by endocrinologists of the ATA ultrasound risk assessment of thyroid nodules shows a high diagnostic performance to identify malignant thyroid nodules before surgery.

Performance of contrast-enhanced ultrasound (CEUS) in assessing thyroid nodules: a systematic review and meta-analysis using histological standard of reference.

The present study was undertaken to systematically review the literature on the reliability of using contrast-enhanced ultrasound (CEUS) to assess thyroid nodules. To avoid the potential bias in studies using a cytological standard of reference, here we aimed to meta-analyze data from studies adopting histological diagnosis as the gold standard. A comprehensive literature exploration of PubMed and Scopus was conducted. The search was updated until June 2018 and references of the retrieved articles screened. Only original articles reporting the histological follow-up of nodules previously undergone CEUS evaluation were eligible for inclusion. Pooled sensitivity, specificity, PPV, and NPV of CEUS were calculated by DerSimonian and Laird method (random-effects model). The literature search retrieved 1885 articles, and 14 were included for the study. There were Chinese, Italian, German, and Austrian authors. All studies used SonoVue. The overall number of reported nodules was 1515, of which 775 were classified as positive at CEUS and 740 as negative. Pooled sensitivity, specificity, PPV, and NPV of CEUS were 85% (95% CI 83-88), 82% (95% CI 77-87), 83% (95% CI 77-88), and 85% (95% CI 81-88), respectively. Moderate inconsistency was present for specificity and PPV. There was publication bias for sensitivity and NPV. CEUS reaches good performance in discriminating between malignant and benign thyroid lesions.

Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era.

Ultrasound (US) has long played a major role in the assessment of thyroid nodules and their risk of malignancy, and its importance has been further enhanced over the past decade by the development of a number of US-based risk stratification systems (US-RSSs), referred to in some cases as TIRADS (Thyroid Imaging Reporting And Data Systems). The high-risk categories of all currently available US-RSSs display strong associations to cytological diagnostic classes of "malignant/suspicious-for-malignancy" and the low-risk classes are clearly associated to "not neoplastic/benign" cytology. The introduction of these systems has elevated the diagnostic performance of US to a level approaching that of fine-needle aspiration (FNA) cytology. The time seems ripe to exploit this new level of accuracy to reduce the number of FNAs for nodules likely to be benign (i.e., sonographically classified as low-risk with no suspicious clinical features). In the near future, US-RSS could also become the main tool for diagnosing papillary thyroid cancers. The establishment of a new "international TIRADS"-currently in progress-will be critical to guide us towards a new era.

Comparison of TIRADS [Thyroid imaging reporting and data system] with histopathology in assessment of thyroid nodules

Introduction: The thyroid gland is an endocrine organ, which acts perfectly in maintaining the normal growth and activity of human beings. Factors causing a disturbance in its auto-regulatory mechanism leads to various thyroid function disorders that may or may not result in thyroid nodules. Malignancy comprises of less than 10% of all thyroid nodules on the basis of already established Breast Imaging Reporting and Data System (BIRADS) for breast nodules a categorization system of ultrasound features in thyroid nodules-the Thyroid Imaging Reporting and Data System (TIRADS) is suggested. Aims and Objectives: To assess validity of TIRADS in Indian population in differentiating thyroid nodules as benign and malignant taking histopathology as gold standard. Methodology: A descriptive study was done at JSS Hospital over a period of 18 months for 82 patients presenting with clinically palpable thyroid nodules and results were drawn assuming 50 percent sensitivity of TIRADS grading in differentiating the lesion as benign and malignant with an alpha error of 5 percent and a precision of 15 percent. All demographic data was summarized as proportion, mean, standard deviation and sensitivity, specificity, positive predictive value, negative predictive value were measured with 95% confidence interval. The inferential statistics were obtained using Chi-square and Cramer’s V tests. Results: 42.7 per cent cases were present in TIRADS II, 34.1 per cent in TIRADS III, 9.8 per cent in TIRADS IV A, 4.9percent each in TIRADS 1V B and C, 3.7 per cent in TIRADS V. TIRADS grading when compared with histopathology was found to have a sensitivity of 82.35 percent, a specificity of 92.30 percent, positive predictive value of 73.68 percent and a negative predictive value of 95.24 percent. Conclusion: TIRADS grading is a useful tool in pre operative evaluation and management, aids in deciding the timing of FNAC and when used along with it improves the diagnostic ability of a clinician in overall assessment of thyroid nodules.