Thyroid Imaging Reporting And Data System Research Articles

Comparison of Incidental Thyroid Nodules Between Early Breast Cancer Patients and Healthy Controls: Higher Incidence and Thyroid Imaging Reporting and Data System (TI-RADS) Score of Patients with Cancer

Background: Breast and thyroid cancers remain among the most common malignancies in women. In previous studies, the co-occurrence of thyroid and breast cancers has been reported. Objectives: The aim of this study was to evaluate and compare the risk and incidence of incidental thyroid nodules (ITNs) between patients with breast cancer and healthy controls, based on the Thyroid Imaging Reporting and Data System (TI-RADS). Methods: This case-control study was conducted on 140 patients with breast cancer and 140 cancer-free women in a similar age range. Thyroid ultrasonography (US) was performed before the onset of treatment. The risk stratification of thyroid nodules was based on the TI-RADS. Results: The mean age of the participants was not significantly different between the case (43.35 ± 7.85 years) and control (42.11 ± 3.69 years) groups (P = 0.094). Invasive ductal carcinoma was the most frequent type of breast cancer in the patients. Normal thyroid US findings were significantly less frequent in patients with breast cancer (35.7%) compared to the healthy controls (76.4%) (P = 0.001). On the other hand, thyroid nodules were more frequent in the patients and associated with a higher risk of malignancy (i.e., high TI-RADS scores) compared to healthy women (P = 0.001 and P = 0.001, respectively). Besides, patients with breast cancer showed more thyroid abnormalities in the US examinations. Conclusions: A higher frequency of ITN, with an elevated TI-RADS score, which raised the suspicion of malignancy, was seen in patients with breast cancer. Overall, patients with breast cancer may benefit from a regular thyroid US examination.

Thyroid Imaging Reporting And Data System (TIRADS) For Ultrasound Features Of Solitary Thyroid Nodules

Abstract Purpose to investigate the Thyroid Imaging Reporting and Data System (TIRADS) as a new classification system for solitary thyroid nodules by high resolution Ultrasonography in correlation with histopathological study. Materials and Methods Thirty patients with clinically suspected thyroid nodules referred to Radiology department at Ain shams University hospitals after fulfilling inclusion and exclusion criteria. All thyroid nodules are examined by ultrasound and charactrized according to internal components, margins, echogenicity, shape and evidence of echogenic foci the classified according to the American college of radiology (ACR) TIRADS guidline, then compared with histopathological examination by Fine needle aspiration cytology (FNAC) . Results Many ultrasound features were predeictors of malignancy hypoechoic echopattern, taller than wider shape, punctate echogenic foci, and lobulated and irregular margins with (p < 0.05). Risk of malignancy on TIRADS 1 and 2 nodules were 0%, also on TIRADS 3 nodules was 0%. While on TIRADS 4 and 5 nodules were 11.1% and 88.9% respectively. ROC analysis revealed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under curve (AUC) are 100, 85.71, 75.00, 100.00 and 0.987 respectively when using cut-off value of score <5. Conclusion Our results suggest that ACR TIRADS classification is reliable in predicting thyroid malignancy. It could lead to a significant decrease of the number of unnecessary FNAC.

EU-TIRADS-Based Omission of Fine-Needle Aspiration and Cytology from Thyroid Nodules Overlooks a Substantial Number of Follicular Thyroid Cancers.

Background The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified. Methods The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings (n = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics (n = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS' sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based. Results The EU-TIRADS score influences decision of FNA in the 10–20 mm range. In such nodules (n = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively (p < 0.01). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) (p=0.02). Conclusions EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10–20 mm range escape surgery.

The value of superb microvascular imaging (SMI) scoring assignment method in differentiating benign and malignant thyroid nodules by conventional ultrasound.

To explore the application value of SMI scoring assignment method combined with 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in differentiating benign and malignant thyroid nodules. According to the 2017 ACR TI-RADS classification, the enrolled nodules were divided into 3 points group, 4 points group, 5 points group, 6 points group and≥7 points group. The nodules were assigned scores according to the echocity of the nodules and the microvessels detected by SMI and their distribution patterns based on ACR TI-RADS. Accompany with the scores increased or decreased after assignment, the thyroid nodules were re-grouped. The AUC after the scores assignment is better than before (Z = 3.881, P < 0.001). The specificity, positive predictive value and accuracy after score assigned are better than those of before (Z = 8.323, P < 0.001; Z = 8.619, P < 0.001; Z = 5.345, P < 0.001), there is no statistical difference in sensitivity before and after score assigned (Z = -0.513, P = 0.60), and the negative predictive value before assigned score is better than that of after (Z = -3.826, P < 0.001). The diagnostic efficacy after scoring was better than that of before.

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).

Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules.

Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%). Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Contrast-Enhanced Ultrasound Improves the Accuracy of the ACR TI-RADS in the Diagnosis of Thyroid Nodules Located in the Isthmus.

To evaluate the diagnostic performance of the American College of Radiology (ACR) Thyroid Image Reporting and Data System (TI-RADS), contrast-enhanced ultrasound (CEUS), and a modified TI-RADS in differentiating benign and malignant nodules located in the isthmus. This retrospective study was approved by the institutional review board. Informed consent was obtained. Grayscale ultrasound (US) and CEUS images were obtained for 203isthmic thyroid nodules (46 benign and 157 malignant) in 198 consecutive patients (156 women, mean age: 44.7years ± 11.3 [standard deviation]; 47 men, mean age: 40.9 years ± 11.0). The area under the receiver operating characteristic curve (AUC) of the diagnostic performance of the ACR TI-RADS, CEUS, and the modified TI-RADS were evaluated. Lobulated or irregular margins (P = 0.001; odds ratio [OR] = 9.250) and punctate echogenic foci (P = 0.007; OR = 4.718) on US and hypoenhancement (P < 0.001; OR = 20.888) on CEUS displayed a significant association with malignancy located in the isthmus. The most valuable method to distinguish benign nodules from malignant nodules was the modified TI-RADS (AUC: 0.863 with modified TR5), which was significantly better than the ACR TI-RADS (AUC: 0.738 with ACR TR5) (P < 0.001) but showed no significant difference with respect to CEUS (AUC: 0.835 with hypoenhancement) (P = 0.205). The diagnostic value was significantly different between CEUS and the ACR TI-RADS (P = 0.028). The modified TI-RADS could significantly improve the accuracy of the diagnosis of thyroid nodules located in the isthmus.

ACR TI-RADS Recommendations: A Call to Contextualize Radiologists' Recommendations for Thyroid Nodules With the Clinical Scenario.

The American College of Radiology incidental findings and Thyroid Imaging Reporting and Data System (TI-RADS™) committees have provided guidance for reporting findings and providing recommendations for the management of patients with thyroid nodules, and these interventions have significantly reduced performance of unnecessary thyroid biopsies [ 1 Hoang J.K. Langer J.E. Middleton W.D. et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015; 12: 143-150 Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar , 2 Tessler F.N. Middleton W.D. Grant E.G. et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017; 14: 587-595 Abstract Full Text Full Text PDF PubMed Scopus (711) Google Scholar ]. ACR guidance spans from incidental thyroid nodules detected on cross-sectional imaging and PET to categorization according to thyroid cancer risk for thyroid nodules evaluated on ultrasound with TI-RADS [ 1 Hoang J.K. Langer J.E. Middleton W.D. et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015; 12: 143-150 Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar , 2 Tessler F.N. Middleton W.D. Grant E.G. et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017; 14: 587-595 Abstract Full Text Full Text PDF PubMed Scopus (711) Google Scholar ]. Evaluation and treatment of thyroid nodules are frequently not the primary concern of patients or of clinicians when they are discovered [ 3 Genere N. Hurtado M.D. Cortes T. et al. Drivers of the decision to biopsy and follow-up of small suspicious thyroid nodules. Endocr Pract. 2020; 26: 857-868 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 4 Singh Ospina N. Iniguez-Ariza N.M. Castro M.R. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ. 2020; 368: l6670 Crossref PubMed Scopus (26) Google Scholar ]. Thyroid nodule evaluation may have been born out of testing unrelated to the thyroid and often is ordered by primary care clinicians who are providing care for multiple other issues. Therefore, clinicians are quite appreciative of specific recommendations for thyroid nodule management according to imaging results.

Utility of Fine-Needle Aspirations to Diagnose Pediatric Thyroid Nodules

Introduction: Risk of malignancy for pediatric thyroid nodules classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is not well defined. Correlations between risk of malignancy and ancillary clinical data remain inconclusive. We report a single institutional experience of fine-needle aspiration (FNA) to improve upon current management paradigm of thyroid nodules. Methods: A retrospective chart review of 575 thyroid nodules was performed of 324 patients who underwent 340 FNAs between 2008 and 2018 at the Children’s Hospital of Philadelphia. Demographics, ultrasound (US) characteristics, FNA cytology, surgical pathology, and ancillary data were reviewed. Results: The rate of malignancy according to TBSRTC was 0.0% for category I, 0.8% for category II, 15.6% for category III, 54.5% for category IV, 100.0% for category V, and 100.0% for category VI. The cumulative Thyroid Imaging Reporting and Data System (TI-RADS) score was significantly correlated with benign and malignant nodules on pathology (p < 2.2e−16). Distribution of TI-RADS for cytologically indeterminate nodules with benign or malignant pathology revealed significant differences for composition (p = 3.20e−8) and echogenic foci (p = 0.005) but not for echogenicity (p = 0.445), shape (p = 0.160), margins (p = 0.220), and size (p = 0.105). Distributions of thyroid-stimulating hormone levels between benign and malignant patients was significant (p = 1.58e−3). Conclusions: Nodules with TI-RADS scores >3 should undergo FNA, irrespective of size; surgical resection is recommended for nodules classified as TBSRTC category IV and V due to high risk of malignancy. US surveillance instead of FNA can be performed for nodules with TI-RADS scores ≤3.

Independent risk factors and feasibility of ultrasound diagnosis of ultrasound-guided non-cytologically diagnostic thyroid nodules.

To explore the independent risk factors and feasibility of ultrasound diagnosis of ultrasound-guided non-cytologically diagnostic thyroid nodules. This study included 200 patients with thyroid nodules that were diagnosed or suspected of being Thyroid Imaging Reporting and Data System (TI-RADS) 4 nodules between January 2017 and January 2019. All patients received surgical treatment and pathological diagnosis, and were divided into a cytologically diagnostic group and a non-cytologically diagnostic group based on whether they could be diagnosed by ultrasound-guided fine needle aspiration cytology (UG-FNAC). Patients were further divided into benign and malignant groups according to the results of surgical pathology. Logistic regression analysis was used to clarify the risk factors that could not be cytologically diagnosed in TI-RADS 4 nodules. For the diagnosis of benign and malignant nodules, we combined contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE) to establish a joint scoring strategy. The diagnostic value of the joint scoring strategy was evaluated by receiver operating characteristic (ROC) curve. A total of 216 TI-RADS type 4 nodules were detected in 200 patients. Among them, 40 nodules were included in the non-cytologically diagnostic group, and 176 nodules were included in the cytologically diagnostic group. The multi-parameter logistic regression showed that: aspect ratio <1, irregular edge, scattered coarse calcification, middle layer, and lower layer were independent influencing factors leading to undiagnosed puncture cytology. Among the 216 nodules in 200 patients, 168 were pathologically diagnosed as malignant nodules (malignant group), and 48 nodules were diagnosed as benign nodules (benign group). According to the joint scoring strategy, the distribution of comprehensive scores changes significantly at 5-6 scores while in malignant nodules, the distribution of comprehensive scores changes significantly at 6-7 scores. ROC curve analysis showed that the diagnostic value was the highest when '6 scores' was used as the critical point for diagnosis [area under curve (AUC) =0.893, P<0.05]. The combined scoring strategy of CEUS and UE was an effective method to diagnose TI-RADS4 nodules could not be diagnosed by UG-FNAC.

Prevalence and predictors of thyroid cancer among thyroid nodules: a retrospective cohort study of 1,000 patients.

Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. The authors recommend management of both STNs and MNG using the same algorithm.

The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls.

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.

Correlation between Age, Nodule Diameter, and TI-RADS Score in Thyroid Nodule Classification on Follicular Thyroid Carcinoma

Background: Thyroid cancer is a malignancy of the endocrine gland with the highest incidence. There are many radiological examination modalities that are used to help diagnose thyroid carcinoma, one of which is Ultrasonography. Ultrasonography (USG) can be useful to support the diagnosis of thyroid malignancy. A classification method that categorizes thyroid nodules based on risk for cancer, one of which is by using the Thyroid Imaging Reporting and Data System (TI-RADS). TI-RADS (Thyroid Imaging, Reporting and Data System) is a classification of thyroid ultrasound readings to differentiate between benign and malignant thyroid nodules. Several research efforts that have been done at Dr. Soetomo Hospital previously related to diagnostic of thyroid carcinoma but the results are meaningless and require large funds for the laboratory examination. The aim of this study is to make a relatively easy and inexpensive method using the TI-RADS classification, which is expected to assist in the preoperative diagnostics of a follicular thyroid carcinoma. It is hoped that there will be a method or modality that is easier, cheaper, accurate, and minimally invasive in predicting a follicular thyroid carcinoma. Methods: In this cross-sectional study, we included patients with thyroid mass who underwent treatment in Surgery Department, Dr. Soetomo Teaching Hospital between January 2012 and December 2020. In this study, we utilized the patients’ medical record to collect the necessary clinical data. The inclusion criteria in this study were patients with singular thyroid nodule, underwent thyroid ultrasound, and diagnosed as follicular nodular carcinoma by histopathology examination. Finally, a total of 53 patients were included for further analysis. Ethical approval was obtained from the Ethics Committee of Dr. Soetomo Teaching Hospital (Surabaya, Indonesia). Results: From a total of 53 research subjects, the subjects with the most age were more than 50 years old with a percentage of 52.8% or 28 patients and the rest, 47.2% or 25 patients. The results of this study indicates that nodule diameters less than 5 cm and more than 5 cm have almost the same number based on the number of data samples in this study, namely 53 patients. This can be seen from the number of respectively 27 (50.9%) and 26 (49%). In the TIRADS nodule score, the largest percentage obtained from medical data records in the form of a TIRADS score, namely a TIRADS score greater than TR 4 with a percentage of 60.4% or as many as 32 patients and the rest, namely a TIRADS score less than TR 4 of 39.6% or as much as 21 patients. In the third dependent variable, the authors looked for the odd ratio value for each variable on follicular carcinoma. The authors calculated the OR values ​​for each variable, obtaining results of 1.012 for age, 1.111 for nodule size, and 3.520 for TIRADS scores. Conclusion: There is a correlation between the TIRADS scores with the incidence of follicular thyroid carcinoma. Keywords: Thyroid cancer, TIRADS, Follicular Thyroid Carcinoma.

Thyroid Nodules in Patients with Acromegaly: Frequency According to the ACR TI-RADS Classification and its Relationship with Disease Activity.

In our study, we aimed to determine the frequency of thyroid nodules in patients with acromegaly according to the American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) classification and its relationship with acromegaly disease activity. A total of 56 patients with acromegaly and age, sex, and body mass index matched with 56 healthy control subjects were included in our study. Thyroid-stimulating hormone, free thyroxine, and anti-thyroperoxidase antibody levels of patients and control subjects were measured. In addition, patients and healthy controls were evaluated by ultrasonography to determine thyroid structure, thyroid volume, and thyroid nodules and to make ACR TI-RADS classification. Thyroid nodules were present in 31 (55.4%) of 56 patients in the acromegaly group and 20 (35.7%) of 56 subjects in the control group, and the frequency of thyroid nodules was significantly higher in the acromegaly group (p=0.038). The mean number of nodules in the acromegaly group and control group was 1.27±1.43 and 0.48±0.73, respectively, and the mean number of nodules was significantly higher in the acromegaly group (p=0.003). The number of patients with TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules in the acromegaly group was higher than the control group (p=0.026, p=0.049, p=0.007, respectively). No difference was found in terms of cytological findings between those who have undergone FNAB in the acromegaly group and control group. In our study, we found that the frequency of thyroid nodules, the number of thyroid nodules, and the number of TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules increased in patients with acromegaly. There was no significant difference between acromegaly disease activity and thyroid nodule frequency, number of thyroid nodules, and TI-RADS classifications.

Ultrasonography and Fine-Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy.

Sonographic risk criteria may assist in further prognostication of indeterminate thyroid nodules (ITNs). Our aim was to determine whether sonographic criteria could further delineate the post-test probability of malignancy in ITNs. Meta-analysis of diagnostic test accuracy. A systematic review of Web of Science, MEDLINE, EMBASE, and CINAHL was performed from inception to April 15, 2021. Eligible studies included those which reported ultrasonographic evaluations with the American Thyroid Association (ATA) or the Thyroid Imaging Reporting and Data System (TIRADS) in adult patients with ITNs. ATA or TIRADS were scored as low (negative) or high (positive) malignancy risk using a previously validated binary classification. Primary outcomes included pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for all sonographic criteria. Studies were appraised using Quality Assessment of Diagnostic Accuracy Studies and the data were pooled using bivariate random-effects models. Seventeen studies were included in the analysis. For Bethesda III, ATA had a specificity (0.90, 95% confidence interval (CI): 0.74-0.94), but a sensitivity of 0.52 (95% CI: 0.25-0.77). Conversely, K-TIRADS had the highest sensitivity (0.78, 95% CI: 0.62-0.89) with a specificity of 0.53 (95% CI: 0.31-0.74). Furthermore, American College of Radiology and EU TIRADS had specificities of 0.60 (95% CI: 0.36-0.80) and 0.81 (95% CI: 0.73-0.87) with sensitivities of 0.70 (95% CI: 0.37-0.90) and 0.38 (95% CI: 0.20-0.60), respectively. There were few studies with Bethesda IV nodules. Though dependent on malignancy rates, Bethesda III nodules with low-suspicion TIRADS features may benefit from clinical observation, whereas nodules with high-suspicion ATA features may require molecular testing and/or surgery. NA Laryngoscope, 132:242-251, 2022.

Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.

A Retrospective Study Correlating Ultrasound Based Thyroid Imaging Reporting and Data System (TIRADS) with Bethesda System for Thyroid Cytopathology in Thyroid Nodule Risk Stratification

Objective: To evaluate the efficacy of the ultrasound-based Thyroid Imaging Reporting and Data System (TIRADS) in estimating the risk of malignancy in thyroid nodules by correlating it with the Bethesda system of thyroid cytopathology. Methods: A retrospective single-center study was conducted in a specialty hospital in UAE from November 2017 to November 2019 on 259 thyroid nodules that underwent ultrasound and fine-needle aspiration cytology (FNAC). Thyroid nodules were evaluated using American College of Radiology (ACR) TIRADS and categorized as benign (TR1), not suspicious (TR2), mildly suspicious (TR3), moderately suspicious (TR4), or highly suspicious (TR5) for malignancy. The risk of malignancy associated with each TIRADS category was evaluated by comparing it with the Bethesda classification system of cytopathology. Results: Ultrasound and FNAC data of 259 nodules were reviewed. Out of these, 33 (12.7%) nodules were excluded because FNAC revealed atypia of undetermined significance or follicular lesion of undetermined significance. The estimated risk of malignancy in TR 3 was 13.6%, TR4 was 27%, and TR5 was 63.6%. There was a statistically significant correlation between TIRADS and Bethesda system, which was determined using the Chisquare test (p &lt; 0.001). The receiver operating curve (ROC) analysis revealed specificity of 81.3% [95% CI, 74.9 - 86.6%], NPV of 91% [95% CI, 87.1 – 93.8%] and accuracy of 77.9% [95% CI, 71.9 – 83.1%], when differentiating benign from malignant nodules. Conclusion: The ultrasound-based ACR-TIRADS scoring correlates well with the Bethesda cytopathology in thyroid nodule risk stratification. Thus, it can be used as a simple and effective tool to decide further management and avoid unnecessary FNAC and surgeries in thyroid nodules.

Clinical value of contrast-enhanced ultrasonography in focal hypoechogenic lesions of thyroid.

The objectives of this study were to analyze the accuracy of contrast-enhanced ultrasonography (CE-US) in diagnosing focal hypoechogenic lesions of the thyroid (FHLT), and to explore the clinical value of CE-US in the diagnosis of FHLT. Patients undergoing CE-US and ultrasound-guided fine needle aspiration (US-FNA) of FHLT at First Hospital of China Medical University between January 2017 and December 2018 were selected for the study; this included patients with papillary thyroid carcinoma (PTC), subacute thyroiditis (SAT) and focal Hashimoto thyroiditis (FHT). All patients underwent color Doppler ultrasonography (CD-US) after which thyroid image reporting and data system (TI-RADS) grading were done. Then, each patient underwent CE-US and US-FNA. The results of the CE-US were analyzed using descriptive statistics. The cytopathological results from the US-FNAs were the gold standard used to confirm the diagnoses. A total of 56 patients were selected for the study. In the PTC group (n = 16), grading was as follows: TI-RADS4a, n = 3; TI-RADS4b, n = 12; and TI-RADS4c, n = 1. More patients with PTC showed heterogeneous hypoenhancement (n = 15) than heterogeneous isoenhancement (n = 1) on CE-US. In the SAT group (n = 24), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 18; TI-RADS4b, n = 5. Fewer patients with SAT showed heterogeneous hypoenhancement (n = 2) than heterogeneous isoenhancement (n = 22) on CE-US. In the FHT group (n = 16), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 11; TI-RADS4b, n = 4. Of those in the FHT group, one patient showed heterogeneous isoenhancement, one patient showed heterogeneous hypoenhancement, and 14 showed uniform isoenhancement on CE-US. The diagnostic accuracy of CD-US alone differed significantly from that of CD-US + CE-US (p < 0.05). CE-US has a high diagnostic accuracy for FHLT and can be used to identify PTC, SAT, and FHT.

Evaluation of the Reliability of US-based TI-RADS in Predicting Thyroid Malignancy

Thyroid nodules are a common and prevalent problem encountered in every day clinical practice. Ultrasound (US) is considered to be the initial imaging modality used in the evaluation of thyroid nodules. The TI-RADS (Thyroid Image Reporting and Data system) is an US-based system used to categorize thyroid nodules and stratify their malignant risk in the aim to standardize reporting and simplify communication among practitioners. The aim of this study is to compare the TI-RADS classification of thyroid nodules on ultrasound with the findings of fine-needle aspiration cytology (FNAC) reported using the Bethesda system. A retrospective study of 59 thyroid nodules that underwent single radiologist bedside neck and thyroid US over a period of one year between January 2020 – January 2021 was performed. The US findings were based on the TI-RADS and all the nodules were eventually subjected to US-guided FNAC. Clinico-pathological retrospective analysis was performed by comparing TI-RADS findings to the Bethesda FNAC classification. Comparing TI-RADS results with the Bethesda system of classification, the risk of malignancy for TI-RADS 2, TI-RADS 3, TI-RADS 4, and TI-RADS 5 were 0%, 10%, 50%, and 100%, respectively. A significant association was noted between the TI-RADS and Bethesda system of classification (P &lt; 0.001). We derived 91.3% sensitivity, 88.9% specificity, 84% positive predictive value, and 94.1% negative predictive value for our study. There is a strong correlation between thyroid sonographic reporting using the TI-RADS and Bethesda cytological classification system for thyroid nodules. The TI-RADS classification is an effective method for risk stratification of thyroid nodules into categories predictive of their malignant potential. This aims to guide further management and facilitate the selection process for fine-needle aspiration biopsy, thus avoiding unnecessary procedures.

Validation of TIRADS ACR Risk Assessment of Thyroid Nodules in Comparison to the ATA Guidelines.

Objectives:The prevalence of thyroid nodules in adults, detected by ultrasound (US), is reported as high as 68%. US-guided fine-needle aspiration biopsy (FNAB) is the test of choice used to determine the nature of the nodules. However, not more than 15% are found to be malignant. Reducing the number of unnecessary FNAB while identifying clinically significant malignant nodules is imperative. There are several guidelines suggested for risk stratification of thyroid nodules by US. The aim of our study was to validate and compare Thyroid Imaging Reporting and Data System (TIRADS) American College of Radiology (ACR) and American Thyroid Association (ATA) risk stratification, specifically pertaining to reduction of unnecessary biopsies.Material and Methods:The study included 281 nodules in 245 patients who underwent FNAB between May 2018 and June 2019. Statistical analysis was performed only on 235 nodules that according to the TIRADS ACR and/ or ATA guidelines were eligible for FNAB. Data collected included nodule characteristics with corresponding TIRADS and ATA grading and cytological results using Bethesda scoring.Results:An agreement was found between the two criteria methods in 58.2% (137/235) of the cases. In 35.3% (83/235), ATA recommended FNAB while TIRADS did not. The specificity for ATA criteria was 7% (15/221) and for TIRADS was 37% (81/221). The sensitivity was 100% (14/14) for ATA and 86% (12/14) for TIRADS.Conclusion:Application of ACR TIRADS criteria can reduce the number of US-guided FNAB performed on benign nodules compared to ATA criteria, by 35%, with a cost of only two missed carcinomas that remained on further follow-up.