Malignancy Rates Of Categories Research Articles

Nodules with nonspecific ultrasound pattern according to the 2015 American Thyroid Association malignancy risk stratification system: A comparison to the Thyroid Imaging Reporting and Data System (TIRADS-Na).

New sonographic patterns have been recommended by the 2015 American Thyroid Association (ATA) to stratify nodules in terms of malignancy risk and help guide biopsy decision. This study aimed to compare the ultrasound part of the ATA guidelines and the Thyroid Imaging Reporting and Data System (TIRADS-Na).In 2013 to 2016, 708 thyroid nodules in 505 patients were confirmed by postoperative histopathology. Hypoechogenicity, solidity, microcalcification, irregular margin, and a taller-than-wide shape were considered features suggesting malignancy. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were obtained for the TIRADS and ATA guidelines.Of the 708 nodules, 341(48.2%) and 367(51.8%) were benign and malignant, respectively. Based on the ultrasound 2015 ATA guidelines, 62 nodules had nonspecific pattern (both malignant and benign features); malignancy rates of nodules with very low, low, intermediate, and high suspicion, and nonspecific pattern were 0, 17.7%, 57.9%, 90.0%, and 69.4%, respectively (P < .001). Malignancy rates of categories 2/3/4/5 nodules by TIRADS were 0, 8.1%, 67.0%, and 90.1%, respectively (P < .001). Based on pathological results, the AUC, sensitivity, specificity, NPV, and PPV were 0.926, 96.7%, 81.5%, 84.9%, and 95.9% for TIRADS, and 0.920, 93.5%, 82.4%, 85.1%, and 92.1% for ATA patterns, respectively. The TIRADS was generally more efficient than the 2015 ATA guidelines, especially for nodules >2 cm in diameter or those with nonspecific pattern.The TIRADS show a relative superiority over the ultrasound 2015 ATA guidelines, especially for nodules with >2 cm diameter or nonspecific pattern.

Evaluation of malignancy with thyroid imaging reporting and data system (TI-RADS) in thyroid nodules with persistent nondiagnostic cytology

Background/aim We aimed to evaluate the utility of thyroid imaging reporting and data system (TI-RADS) in prediction of malignancy in thyroid nodules with persistent nondiagnostic (ND) cytology. Materials and methodsA total of 246 thyroid nodules which were surgically removed and had at least two fine-needle aspirations (FNAs) with ND cytology were included in this study. Ultrasonography features and TI-RADS scores were recorded. Results Of 246 nodules, 218 (88.6%) had benign and 28 (11.4%) had malignant final histopathology. Frequencies of taller than wide shape, solidity, hypoechogenicity, microcalcifications, and presence of irregular borders were similar between benign and malignant nodules (P > 0.05). The number of nodules categorized as TI-RADS 3, 4a, 4b, and 4c were 12 (4.9%), 53 (21.5%), 104 (42.3%), and 77 (31.3%), respectively. There was not any nodule in TI-RADS 5 category. Malignancy rates of categories 3, 4a, 4b, and 4c were 0%, 13.2%, 9.6%, 14.3%, respectively. No significant differences were detected in TI-RADS categories between benign and malignant nodules (P > 0.05).ConclusionIn this study, we did not demonstrate any suspicious ultrasound (US) finding predictive for malignancy in thyroid nodules with persistent ND cytology and did not determine any difference between malignant and benign nodules regarding TI-RADS scores. Whereas, we found that thyroid nodules in 4a, 4b, and 4c TI-RADS categories had higher malignancy rates than those previously reported in ND cytology. We think that TI-RADS categories in thyroid nodules with persistent ND cytology can be helpful in treatment decision.

Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy

Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. However, there are very few data regarding the influence of TSH non-suppressive thyroid hormone therapy (NSTHT) on the risk of malignancy in patients in the aforementioned categories. We assessed the number of patients with thyroid nodules assigned to categories III and IV who take TSH NSTHT and if thyroid hormone therapy is associated with a rate of malignancy. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. All participants underwent surgery, and histopathological verification was obtained in all cases. In all, 33.1% of individuals with category III and IV thyroid nodules took TSH NSTHT. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR = 0.55, p = 0.381). In patients with category IV nodules, we demonstrated a significantly lower rate of TC when NSTHT was applied (OR = 0.44, p = 0.005). In conclusion, the prevalence of patients with Bethesda System category III and IV thyroid nodules who take NSTHT is high. TSH NSTHT significantly decreases a rate of malignancy in category IV, but not category III patients.

Comparative evaluation of Bethesda system with conventional reporting method in assessment of thyroid malignancy rate

Introduction: Fine needle aspiration cytology (FNAC) of thyroid is non-invasive, cost-effective & extremely useful technique in identifying a substantial proportion of thyroid nodules as benign & appropriately triages patients with thyroid cancer to appropriate surgery. The Bethesda system for reporting thyroid cytology represents a major step towards improved clinical significance, reproducibility, standardization & greater predictive value of FNAC thyroid. Objective: To categories thyroid lesions according to Bethesda system & to determine the rate of malignancy in each cytologic category by correlating the result with histopathologic diagnosis on the resected specimens. Material & Methods: The present study was carried out on 100 patients of thyroid swelling referred to the department of pathology, for FNAC. The reporting was done by using Bethesda system of thyroid cytopathology in comparison to the conventional reporting system. The malignancy rate based on final histopathologic evaluation was analyzed for each of the cytologic groups. Results: Rates of malignancy in each category of conventional system reported on follow up HPE were 16.66% in non-diagnostic group, 2.17% in colloid garter, nil in colloid cyst, 25% in thyroiditis, 7.69% in follicular lesion/ neoplasm, 33.33% in indeterminate group, 75% in suspicious for malignancy & 100% in malignant category. Rates of malignancy in each category of Bethesda system on follow up HPE were 16.66% in Non Diagnostic, 1.58% in benign category, 28.57% in atypical of undermined significance, 18.18% in suspicious for follicular neoplasm, 80% in suspicious for malignancy & 100% in malignant category. Conclusion: By adapting the Bethesda cyto-pathology reporting system malignancy risk in the categories of AFLUS, SM & Malignant category help to determine a better patient outcome due to proper clinical management.

Lung-RADS Category 4X: Does It Improve Prediction of Malignancy in Subsolid Nodules?

Purpose To evaluate the added value of Lung CT Screening Reporting and Data System (Lung-RADS) assessment category 4X over categories 3, 4A, and 4B for differentiating between benign and malignant subsolid nodules (SSNs). Materials and Methods SSNs on all baseline computed tomographic (CT) scans from the National Lung Cancer Trial that would have been classified as Lung-RADS category 3 or higher were identified, resulting in 374 SSNs for analysis. An experienced screening radiologist volumetrically segmented all solid cores and located all malignant SSNs visible on baseline scans. Six experienced chest radiologists independently determined which nodules to upgrade to category 4X, a recently introduced category for lesions that demonstrate additional features or imaging findings that increase the suspicion of malignancy. Malignancy rates of purely size-based categories and category 4X were compared. Furthermore, the false-positive rates of category 4X lesions were calculated and observer variability was assessed by using Fleiss κ statistics. Results The observers upgraded 15%-24% of the SSNs to category 4X. The malignancy rate for 4X nodules varied from 46% to 57% per observer and was substantially higher than the malignancy rates of categories 3, 4A, and 4B SSNs without observer intervention (9%, 19%, and 23%, respectively). On average, the false-positive rate for category 4X nodules was 7% for category 3 SSNs, 7% for category 4A SSNs, and 19% for category 4B SSNs. Of the falsely upgraded benign lesions, on average 27% were transient. The agreement among the observers was moderate, with an average κ value of 0.535 (95% confidence interval: 0.509, 0.561). Conclusion The inclusion of a 4X assessment category for lesions suspicious for malignancy in a nodule management tool is of added value and results in high malignancy rates in the hands of experienced radiologists. Proof of the transient character of category 4X lesions at short-term follow-up could avoid unnecessary invasive management. © RSNA, 2017.

The 5-tiered categorization system for reporting cytology is sufficient for management of patients with thyroid nodules compared to the 6-tiered Bethesda system.

To analyze whether the 5-tiered categorization system without the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category is sufficient compared to the 6-tiered Bethesda system. This IRB-approved retrospective study was waived informed consent. The pre-Bethesda period was from March 2008 to December 2008 and the Bethesda period was from January 2012 to January 2013. Of 4677 nodules ≥10mm with initial ultrasonography-guided fine-needle aspiration, 2553 nodules were from the pre-Bethesda period and 1754 nodules were from the Bethesda period. The utilization and malignancy rates of each category were compared between the two periods. The utilization rate of the benign category decreased from 67.7% in the pre-Bethesda period to 60.0% in the Bethesda period (p=0.001). In the pre-Bethesda period, the malignancy rates of the non-diagnostic, benign, suspicious follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy, and malignancy categories were 3.8, 1.9, 25, 78.8, and 99.7%, respectively. The malignancy rate of the benign category decreased from 1.9 to 0.3% after the Bethesda system (p<0.001). The utilization and malignancy rates of the AUS/FLUS category were 7 and 22.8%. When the AUS/FLUS category was included in the benign category, the malignancy rate became 2.6% which was not significantly different from 1.9% in the pre-Bethesda period (p=0.189). The malignancy rates of other categories were not significantly different. The 5-tiered categorization system without the AUS/FLUS category for reporting cytology was sufficient for management of patients with thyroid nodules compared to the 6-tiered categorization of the Bethesda system.

Shear Wave Elastography: Is It a Valuable Additive Method to Conventional Ultrasound for the Diagnosis of Small (≤2 cm) Breast Cancer?

The aim of this study is to evaluate the diagnostic value of shear wave elastography (SWE) added to conventional ultrasound (US) in the diagnosis of small (≤2 cm) breast cancer.Among 410 patients who underwent SWE before US-guided biopsy from June 2012 to June 2013, 171 patients (mean age: 45.17 ± 9.37 years) with 177 small (≤2 cm) breast lesions were enrolled in this study. Diagnostic performances of each quantitative SWE parameters were calculated by receiver operating characteristic (ROC) curves. Performances of conventional US and US combined to SWE was also compared. Histologic diagnosis was used as a reference standard.Of the 177 lesions, 22 lesions (12.4%) were malignant and 155 (87.6%) were benign. With respect to conventional US, when a cutoff point between category 3 and 4a was used, the Az value was 0.915 (100% sensitivity, 36.8% specificity, 18.3% positive predictive value (PPV), and 100% negative predictive value (NPV)). All average quantitative elastography values were significantly higher in malignant lesions compared to benign lesions (P = 0.001).The Emax value with a cutoff of 87.5 kPa had the highest Az value of 0.796 (68.2% sensitivity and 87.1% specificity, 42.9% PPV, and 95.1% NPV). Az value of combined data (0.861, 95% CI: 0.801, 0.909) was significantly lower than that of conventional US alone (P = 0.02). By using an Emax value for downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a lesions to category 3, 76/94 category 4a lesions (80.9%) were downgraded. After downgrading, 5 cancers were missed and the malignancy rate of category 3 lesions increased from 0% (0/55) to 3.8% (5/133) (P = 0.01).In conclusion, combined use of SWE and conventional US increased the specificity by reducing the number of unnecessary biopsies in differential diagnosis of small breast lesions. However, we propose that the application of conservative strategy for downgrading of soft category 4a lesions would be appropriate to minimize false-negative cases.

Bosniak Category IIF Designation and Surgery for Complex Renal Cysts

We investigated whether adding the IIF categorization improved the accuracy of Bosniak renal cyst classification, as evidenced by a low rate of progression in IIF lesions and a high rate of malignancy in category III lesions. We retrospectively reviewed the records of patients with complex renal cysts categorized as a Bosniak IIF or III. Surveillance imaging and pathological outcomes of category IIF cysts were recorded to determine radiological predictors of progression. Pathological outcomes of category III cysts were recorded to determine the malignancy rate. A total of 112 patients met study inclusion criteria, of whom 81 were initially diagnosed with a category IIF cyst and 31 had a Bosniak category III cyst. At a median followup of 15 months 14.8% of Bosniak IIF lesions progressed in complexity with a median time to progression of 11 months (maximum greater than 4 years). There were no differences in tumor or patient characteristics between cysts that progressed and those that remained stable. In the 33 patients with Bosniak III lesions who underwent surgical extirpation the malignancy rate was 81.8%. Most patients had low stage, low grade disease and remained recurrence-free at a median followup of 6 months. Adding the IIF category has increased the accuracy and clinical impact of the Bosniak categorization system, as evidenced by a low rate of progression in category IIF cysts and an increased rate of malignancy in surgically treated category III lesions compared to those in historical controls.