Thyroid Imaging Reporting And Data System 4b Research Articles

Comparison of the diagnostic performance and clinical role of different ultrasound-based thyroid malignancy risk stratification systems for medullary thyroid carcinoma.

This study sought to investigate the applicability of different ultrasound (US) thyroid risk stratification systems in diagnosing medullary thyroid carcinoma (MTC) and determining the need for biopsy. In total, 34 MTC nodules, 54 papillary thyroid carcinoma (PTC) nodules, and 62 benign thyroid nodules were examined in this study. All the diagnoses were histopathologically confirmed postoperatively. All the thyroid nodule sonographic features were recorded and categorized by 2 independent reviewers according to the Thyroid Imaging Reporting and Data System (TIRADS) of the American College of Radiology (ACR), the American Thyroid Association (ATA) guidelines, the European Thyroid Association (EU) TIRADS, the Kwak-TIRADS, and the Chinese TIRADS (C-TIRADS). The sonographic differences and risk stratifications of the MTCs, PTCs, and benign thyroid nodules were analyzed. The diagnostic performance and recommended biopsy rates for each classification system were evaluated. The risk stratifications of MTCs were all higher than the benign thyroid nodules (P<0.01) and lower than PTCs (P<0.01) with each classification system. Hypoechogenicity and malignant marginal features were independent risk factors for identifying malignant thyroid nodules, and the area under the receiver operating characteristic curve (AUC) for identifying MTCs was lower than that for identifying PTCs (0.873 vs. 0.954, respectively). The AUCs, sensitivity, specificity, positive predictive values, negative predictive values, and accuracy values of the 5 systems for MTC were all lower than those for PTC. The best cut-off values for diagnosing MTC were TIRADS (TR) 4 in the ACR-TIRADS, intermediate suspicion in the ATA guidelines, TR 4 in EU-TIRADS, and TR 4b in both the Kwak-TIRADS and the C-TIRADS. The Kwak-TIRADS had the highest recommended biopsy rate for MTCs (97.1%), followed by the ATA guidelines, the EU-TIRADS (88.2%), the C-TIRADS (85.3%), and the ACR-TIRADS (79.4%). The US-based thyroid malignancy risk stratification systems analyzed in this study were able to satisfactorily identify MTC and recommend biopsy, but the diagnostic performance of these systems for MTC was not as good as that for PTC.

The Value of Ultrasound in Classification of Thyroid Hypoechoic Nodules

This study evaluates the value of ultrasound in classifying hypoechoic nodules of thyroid of 70 patients at the Department of Diagnostic Imaging and Oncology of E Hospital from January 2019 to December 2019. The study results show that the patients’ average age was 55.29 ± 13.7; the female/male ratio was approximately 6.5/1; patients with a history of radiotherapy to the neck area and chronic thyroid disease had a very high risk of developing cancer; homogeneous hypoechoic nodules had a higher risk of malignancy than the heterogeneous; the sign of height ≥ width had the diagnostic value of thyroid malignant nodule with Se = 57.8%, Sp = 89.6%, PPV = 88%, NPV = 89.6%, Acc = 41.4%, OR = 10.03; the sign of border irregularity had the diagnostic value of thyroid malignant nodule with Se = 77.8%, Sp = 80%, PPV = 87.5%, NPV = 66.7%, Acc = 57.1%, OR = 14; microcalcification has a diagnostic value of thyroid malignant nodule with Se = 71.1%, Sp = 56%, PPV = 17.4%, NPV = 51.9%, Acc = 57.1%, OR = 3.1. TIRADS 4B, 5 actually had a higher risk of malignancy than TIRADS 4A. The study concludes that ultrasound has a great value in orienting malignant lesions of hypoechonic thyroid nodules.&#x0D; Keywords: Thyroid nodule, thyroid hypoechoic nodule, TIRADS.&#x0D; References&#x0D; [1] F. Bray, J. Ferrlay, I. Soerjomataram et al., Global Cancer statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries, CA: A Cancer Journal for Clinicians, Vol. 68, No. 6, 2018, pp. 394-424. https://doi.org/full/10.3322/caac.21492.[2] E. Papini, R. Guglielmi, A. Bianchini, A. Crescenzi et al., Risk of Malignancy in Nonpalpable Thyroid Nodules: Predictive Value of Ultrasound and Color-Doppler Features, The Journal of Clinical Endocrinology &amp; Metabolism, Vol. 87, No. 5, 2002, pp. 1941-1946, https://doi.org/10.1210/jcem.87.5.8504.[3] T. T. Hong, Image Characteristics and Value of Ultrasound in the Diagnosis of Localized Thyroid Lesions, Master of Medicine Thesis Majoring in Diagnostic Imaging of Hanoi Medical University, 2013 (in Vietnamese).[4] V. T. Giao, Research on Ultrasound Values in TIRADS Classification of Localized Thyroid Lesions, Master of Medicine Thesis Majoring in Diagnostic Imaging, Hanoi Medical University, 2015 (in Vietnamese).[5] B. Y. Cho, H. S. Choi, Y. J. Park, J. A. Lim, H. Y. Ahn et al., Changes in the Clinicopathological Characteristics and Outcomes of Thyroid Cancer in Korea Over the Past Four Decades, Thyroid, Vol. 23, No. 7, 2013, pp. 797-804, https://doi.org/10.1089/thy.2012.0329.[6] C. M. Oh, S. Park, J. Y. Lee et al., Increased Prevalence of Chronic Lymphocytic Thyroiditis in Korean Patients With Papillary Thyroid Cancer, PLoS One, Vol. 9, No. 6, 2014, pp. 1-7, https://doi.org/10.1371/journal.pone.0099054.[7] G. Grani, L. Lamartina, V. Ramundo, R. Falcone, et al., Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems, Eur Thyroid J, Vol. 9, No. 2, 2020, pp. 85-91, https://doi.org/10.1159/000504219.[8] B. Moifo, E. O. Takoeta, J. Tambe et al., Reliability of Thyroid Imaging Reporting and Data System (TIRADS) Classification in Differentiating Benign from Malignant Thyroid Nodules, Open Journal of Radiology, Vol. 3 No. 3, 2013, pp. 103-107, http://dx.doi.org/10.4236/ojrad.2013.33016.[9] H. J. Moon, J. Y. Kwak, M. J. Kim et al, Can Vascularity at Power Doppler US Help Predict Thyroid Malignancy?, Radiology, Vol. 255, 2010, pp. 260-269, https://doi.org/10.1148/radiol.09091284.[10] E. Horvath, S. Majlis, R. Rossi et al., An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management, J Clin Endocrinol Metab, Vol. 94 No. 5, 2009, pp. 1748-1751, https://doi.org/10.1210/jc.2008-1724.[11] G. Russ, B. Royer, C. Bigorgne et al., Prospective Evaluation of Thyroid Imaging Reporting and Data System on 4550 Nodules With and Without Elastography, Eur J Endocrinol, Vol. 168, No. 5, 2013, pp. 649-655, https://doi.org/10.1530/EJE-12-0936.[12] J. H. Shin, J. H. Baek, J. Chung et al., Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations, Korean J. Radiol., Vol. 17, No. 3, 2016, pp. 370-395, https://dx.doi.org/10.3348%2Fkjr.2016.17.3.370.[13] F. N. Tessler, W. D. Middlenton, E. G. Grant et al., ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee, J Am Coll Radiol., Vol. 14, No. 5, 2017, pp. 587-595, https://doi.org/10.1016/j.jacr.2017.01.046.[14] N. T. T. Thao, N. L. Lam, V. D. Luu, Research Into the Value in the Diagnosis of Thyroid Cancer of the EU-TIRADS 2017 Classification, Vietnamese Journal of Radiology, No 33, 2019, pp. 12-18, https://radiology.com.vn/bao-cao-khoa-hoc/nghien-cuu-gia-tri-chan-doan-ung-thu-tuyen-giap-cua-phan-do-eu-tirads-2017-n125.html/, (accessed on: Deceber 4th, 2019) (in Vietnamese).

Applicational value of 2017 ACR TI-RADS stratification in diagnosing thyroid nodules

To summarize and evaluate the value of applying the thyroid imaging reporting and data system (TI-RADS) released by American College of Radiology (ACR) in 2017 of the thyroid classification, and to propose an optimized classification method based on the result to facilitate more accurate and precise risk stratification of thyroid nodules. In the study, 342 thyroid nodules assessed by 2017 ACR TI-RADS were retrospectively analyzed. Each nodule had a score, and all the scores of nodules were compared with the pathological results. The proportion of malignant nodules in different scoring ranges was obtained. The diagnostic efficacy of all nodules, nodules above 1 cm and less than or equal to 1 cm was evaluated by ROC curve, respectively. The AUC of all nodules, nodules above 1 cm and less than or equal to 1 cm were 0.907, 0.936 and 0.717, respectively. With the increase of the scores, the proportion of benign nodules decreased gradually, and the proportion of malignant nodules increased, especially nodules of 4-6 scores increased significantly. Based on the proportion of malignant nodules with 3 scores, the proportion of malignant nodules with 4, 5 and 6 scores increased 1.6, 3.8 and 5.3 times, respectively. The proportion of malignant nodules with 6-8 scores was 81%-84%, while the proportion of malignant nodules with 9 scores or more was 93%-94%. According to the distribution characteristics of malignant nodules, the classification of TI-RADS was adjusted. TI-RADS 4 was divided into TI-RADS 4a, TI-RADS 4b and TI-RADS 4c, corresponding to 4, 5 and 6-8 scores respectively, while the nodules with 9 scores or more were divided into TI-RADS 5. 2017 ACR TI-RADS has high diagnostic value for thyroid nodules above 1 cm, but it is not so effective for the nodules less than or equal to 1 cm. According to the proportion distribution of malignant nodules in different scoring ranges, appropriate adjustment of classification will be more accurate and precisely predict the malignant risk of nodules.

Feasibility of Thyroid Imaging Reporting and Data System Classification in Predicting Thyroid Malignancy

In this study, we aimed to evaluate the diagnostic value of thyroid imaging reporting and data system (TIRADS) in the estimation of malignancy and assess the concordance between TIRADS and the histopathology results of the postoperative specimens. Consecutive ultrasound imaging records of patients with multinodular goiter from January 2010 to December 2017 who underwent surgery were retrospectively reviewed. The risk of malignancy of each TIRADS category was determined, and correlation with pathology was assessed. The patients with malignant cytology findings (Bethesda 6) who were categorized TIRADS 6 were excluded from the study. The positive and negative predictive values, sensitivity, specificity, and accuracy of the TIRADS classification were calculated on a 2 × 2 table with their own formulas. A total of 1457 patients were evaluated, and 1122 of these were included in the study. The risk of malignancy for nodules evaluated as TIRADS 2 was 0.6 per cent, TIRADS 3 was 13.1 per cent, TIRADS 4a was 20 per cent, TIRADS 4b was 61.1 per cent, TIRADS 4c was 85.7 per cent, and TIRADS 5 was 93.3 per cent. The positive predictive value of TIRADS classification was found to be 43.4 per cent, negative predictive value was found to be 90.7 per cent, sensitivity was found to be 78 per cent, specificity was found to be 68.4 per cent, and accuracy was found to be 70.7 per cent for our institution. The TIRADS classification based on suspicious ultrasound findings is reliable in predicting thyroid malignancy and can be routinely used in daily practice.

Diagnostic Accuracy of Contrast-Enhanced Ultrasonography in Papillary Thyroid Microcarcinoma Stratified by Size

We explored the diagnostic accuracy of ultrasonography (US) in papillary thyroid microcarcinoma (PTMC), studying nodular growths according to size via 3-D color Doppler US (3-DCDUS) and contrast-enhanced US (CEUS). A total of 109 patients undergoing CEUS and surgery of thyroid nodules at the First Hospital of China Medical University between January 2017 and December 2018 were selected for the study, including 77 with post-operative pathologically confirmed PTMC (test group) and 32 with nodular goiter (controls). All nodules were ≤1.0 cm in maximum diameter. After 3-DCDUS, each patient underwent Thyroid Imaging Reporting and Data System (TI-RADS) grading. In both groups, receiver operating characteristic curve analysis of anteroposterior (AP) nodule diameters was conducted, establishing a cutpoint for probable malignancy by CEUS. In the test group (n = 77), grading was as follows: TI-RADS 4a, 23; TI-RADS 4b, 40; TI-RADS 4c, 14. More patients had heterogeneous enhancement or hypo-enhancement (n = 55) than uniform hyper-enhancement or uniform iso-enhancement (n = 22) by contrast-enhanced ultrasonography (CEUS). Control group (n = 32) grading was as follows: TI-RADS 3, 1; TI-RADS 4, 21; TI-RADS 4b, 10. Fewer patients had heterogeneous enhancement or hypo-enhancement (n = 12) than uniform hyper-enhancement or uniform iso-enhancement (n = 20) by CEUS. The diagnostic accuracy of 3-DCDUS or CEUS differed significantly from that of 3-DCD-US + CEUS (p < 0.05), whereas 3-DCDUS and CEUS performed similarly (p > 0.05). At AP diameters of 0.66 cm, the Youden index for diagnosing malignancy by CEUS was maximal. When nodules below this threshold were excluded, both CEUS and 3-DCDUS + CEUS improved significantly in diagnostic accuracy (p < 0.05). CEUS is useful in determining the status (benign vs. malignant) of thyroid nodules, with significantly better accuracy at AP diameters ≥0.66 cm.

Application of superb microvascular imaging and contrast enhanced ultrasound in the differential diagnosis of thyroid nodules

To compare the clinical value of superb microvascular imaging (SMI) and contrast enhanced ultrasound (CEUS) in the differential diagnosis of thyroid nodules, and to further study whether the combination of SMI and/or CEUS with thyroid imaging reporting and data system (TI-RADS) can improve the diagnostic value of TI-RADS. Methods: SMI, CEUS, TI-RADS, TI-RADS combined with CEUS, TI-RADS combined with SMI, TI-RADS combined with SMI and CEUS were used to differentiate thyroid nodules. TI-RADS 4b, 5 categories in two-dimensional ultrasound, hypoenhancement in CEUS, and peripheral blood flow with penetrating vessels in SMI were considered malignant signs. The diagnostic efficacy of these methods was compared according to post-operative pathology or fine needle aspiration cytology. Results: A total of 237 patients with 296 thyroid nodules were included in the study. The sensitivity, specificity and accuracy for TI-RADS were 78.4%, 77.7% and 78.0% respectively, 75.5%, 86.6% and 81.4% in SMI, 82.0%, 88.5% and 85.5% in CEUS, 92.1%, 90.4% and 91.2% in TI-RADS combined with SMI and CEUS. Area under the receiver operating characteristic curve (AUROC) showed no significant difference between SMI, CEUS, TI-RADS (χ2=4.29, P=0.117). AUROC of both TI-RADS combined with CEUS (χ2=39.62, P<0.001), TI-RADS combined with SMI (χ2=36.61, P<0.001) were higher than TI-RADS. AUROC of TI-RADS combined with SMI and CEUS was higher than TI-RADS combined with SMI (χ2=4.50, P=0.033) or TI-RADS combined with CEUS (χ2=4.24, P=0.039). Conclusion: Peripheral blood flow with penetrating vessels in SMI possesses high diagnostic value in differentiating thyroid cancer. The combination of SMI and/or CEUS with TI-RADS can be used to improve the diagnostic efficacy of TI-RADS in differential diagnosis of thyroid nodules.

Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules.

To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness. Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated. The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7mm (3-60mm). Malignancy was 0% (0/116) in TIRADS 2, 1.79% (1/56) in TIRADS 3, 76.13% (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88% (1/17), TIRADS 4B 62.82% (49/78), TIRADS 4C 91.22% (135/148)], and 98.85% (86/87) in TIRADS 5. With a cut-off point at TIRADS 4-5 to perform FNAB, we obtained: sensitivity 99.6% (95% CI: 98.9-100.0), specificity 74.35% (95% CI: 68.7-80.0), PPV 82.1% (95% CI: 78.0-86.3), NPV 99.4% (95% CI: 98.3-100.0), PLR 3.9 (95% CI: 3.6-4.2) and an NLR 0.005 (95% CI: 0.003-0.04) for malignancy. US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk. • TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4-5). • The recognition of benign/possibly benign patterns can avoid unnecessary procedures. • This classification and its sonographic patterns are validated using surgical specimens.

Thyroid Imaging Reporting and Data System (TI-RADS): the impact of Quantitative Strain Elastography for better stratification of cancer risks.

Due to the elevated prevalence of the solid thyroid nodules in a general population, an appropriate selection of cases referred to surgery is of paramount importance. The main aim of our study was to evaluate the performance of the Thyroid Imaging Reporting and Data System (TI-RADS) as a differential diagnosis tool for thyroid nodules. We evaluated 174 nodules using TI-RADS risk stratification model, using conventional ultrasound and real time elastography parameters and linear multifrequency probe (Hitachi Preirus Machine, Hitachi Inc., Japan). All the nodules were classified using the TI-RADS system according to echogenicity, margins, shapes, calcification, lymph nodes, and increased strain ration. The results were compared with the pathology exam, which was considered the golden standard diagnosis. The prevalence of malignant nodules was 16.7% (29 cases). The differential diagnosis performance regarding the malignant tumor for TI-RADS is appropriate for clinical use, obtaining an area under ROC curve of 0.95761 [0.8424-0.989] 95% confidence interval. Combining TI-RADS 2, 3 and 4A as probably benign and TI-RADS 4B and 5 as probably malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 97.93%, 86.20%, 97.26% and 89.28% respectively. The overall accuracy of the method was 95.97%.According to the American Association of Clinical Endocrinologists Guidelines, 169 cases required FNAB examination; by applying the TI-RADS scoring system, the necessity for FNAB would decrease to 74 cases. Quantitative strain elastography, as the 6th parameter of TI-RADS system, adds diagnostic power to the risk stratification model.

Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology.

The cytological diagnosis of follicular neoplasm (Thy3F) remains a diagnostic challenge. The main aim of this study was to stratify the risk of malignancy in thyroid nodules diagnosed as Thy3F on cytology (Thy3F) using thyroid imaging reporting and data system (TIRADS). A database of thyroid nodules with Thy3F cytological results from ultrasound-guided FNA (US-FNA) between January 2007 and March 2014 was studied retrospectively. Information on patient demographics, ultrasound characteristics and final histology of the nodules was collated. The number of suspicious US features of each thyroid nodule was counted based on TIRADS. The malignancy rate of each of the TIRADS category was also calculated based on the final histological outcomes of the nodules and compared to that calculated using a recently proposed thyroid malignancy risk prediction model. The overall malignancy rate of Thy3F cytology was 24·3%. There were significantly higher percentages of malignant nodules with irregular margins (20·0% vs 0%, P = 0·000), hypo-echogenicity (74·3% vs 51·4%, P = 0·013) and taller-than-wide morphology (17·1% vs 0·9%, P = 0·001) when compared to benign nodules. The risk of malignancy increased with advancing TIRADS score: TIRADS 4A (14·3%), TIRADS 4B (23·1%), TIRADS 4C (87·5%) and TIRADS 5 (100%). The malignancy rate calculated using the prediction model similarly increased with advancing TIRADS score: TIRADS 4A (6·2%), TIRADS 4B (32·5%), TIRADS 4C (79·9%) and TIRADS 5 (90%). Thyroid nodules with TIRADS scores 4C and 5 should be considered for single definitive surgery in view of the high malignant rate.

Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology.

The thyroid imaging reporting and data system (TI-RADS) was designed to better select patients who had undergone fine-needle aspiration biopsies (FNABs) with high sensitivity and accuracy. However, the combination of TI-RADS scores and Bethesda system categories in indeterminate thyroid nodules has not been examined extensively. This study aimed to stratify indeterminate thyroid nodules (Bethesda categories III, IV and V) according to risk of malignancy as determined by combining TI-RADS score with Bethesda system classification. Retrospective study. Histopathological, cytological and ultrasound (US) data were available for 242 cases after surgery, including 136 indeterminate nodules. All thyroid cytopathological slides and US reports were reviewed and classified according to Bethesda system and TI-RADS categories. The malignancy rate was determined for each Bethesda category, TI-RADS score and both methods combined of indeterminate nodules. The malignancy rates were 8·7%, 51·3% and 67·5% for Bethesda categories III, IV and V, respectively. Based on histopathological comparison, the accuracy was 66·7% for TI-RADS greyscale. TI-RADS 3 and 4A scores were observed in 80% of Bethesda III cases, which led to 80% sensitivity and 90% of negative predictive value (NPV). In contrast, for nodules scored as TI-RADS 4B and 5, the combined cytological results of Bethesda IV and V resulted in a higher risk of malignancy (75% and 76·9%, respectively, P < 0·001). In view of the high NPV of TI-RADS 3/4A only in Bethesda III category, a surgical approach could be considered for lesions defined as Bethesda III, IV and V when TI-RADS 4B and 5 were concomitant.