Thyroid Imaging Reporting Research Articles

Comparison of diagnostic performance and FNA management of the ACR-TIRADS and Chinese-TIRADS based on surgical histological evidence.

The sonography-based risk stratification of thyroid nodules is based on the different sonographic features of benign and malignant thyroid nodules. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) and the Chinese-TIRADS define different risks for malignancy categories and the size criteria for fine-needle aspiration (FNA). Few studies have compared their diagnostic performance and FNA management approaches. Thus, we sought to compare the diagnostic performance and FNA management approaches of the ACR-TIRADS and Chinese-TIRADS based on surgical histological evidence. This retrospective study included patients with complete thyroid ultrasound images and histologic evidence who were consecutively selected from The Affiliated Hospital of Nanjing University of Chinese Medicine. A total of 333 nodules from 252 patients with definitive surgical histological findings were examined. Ultrasonography categories and FNA management proposals were assigned according to the ACR-TIRADS and Chinese-TIRADS. The thyroid nodules were divided into 2 groups based on a cut-off size of 1 cm. The diagnostic performance and recommended and unnecessary FNA rates for each group were compared for both systems. Overall, 280 malignant thyroid nodules (84.1%) and 53 benign nodules (15.9%) were analyzed. Across all groups, the ACR-TIRADS had higher sensitivity, specificity, positive and negative predictive values, and accuracy, and a higher area under the curve (AUC) than the Chinese-TIRADS. However, there was a significant difference in the negative predictive value between the ACR-TIRADS and Chinese-TIRADS of <1 and ≥1 cm, and the overall AUCs differed significantly (39.5% vs. 35.1%, P=0.007 for <1 cm; 70.0% vs. 62.8%, P=0.014 for ≥1 cm; 0.843 vs. 0.806, P=0.037 for all). The rate for recommending the FNA of the nodules in the ACR-TIRADS was lower than that in the Chinese-TIRADS (25.2% vs. 56.5%, P<0.0001), but there was no significant difference between the ACR-TIRADS and Chinese-TIRADS in terms of the unnecessary FNA rate (14.3% vs. 13.8%, P=0.931). The kappa statistics for the consistency of the ACR-TIRADS and Chinese-TIRADS FNA recommendations for nodules sized ≥1.0 to <1.5, ≥1.5 to <2.5, and ≥2.5 cm were 0.084, 0.635, and 0.909, respectively. The ACR-TIRADS had slightly better diagnostic performance and a lower recommended FNA rate than the Chinese-TIRADS for thyroid nodules. For thyroid nodules ≥1.5 cm in size, the FNA recommendations of the 2 guidelines had good consistency.

The Prevalence and Associated Predictors for Diabetes Mellitus in Adult Patients With Thyroid Nodules.

Diabetes mellitus (DM) and thyroid nodules (TNs) with the risk of malignancy are increasing globally. Hence, we conducted this study to evaluate the prevalence and the associated predictors for DM among adult patients with TNs in Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). A retrospective study was conducted between January 1, 2015 and December 31, 2021. Patients with documented TNs based on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) were recruited. Then the prevalence and associated risk factors for DM were assessed. Three hundred ninety-one patients who had TNs were recruited. The median (interquartile range (IQR)) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. There was a high prevalence of DM (24.0%) among adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age, gender, 25-hydroxyvitamin D (25(OH)D) level, hypertension, bronchial asthma, free triiodothyronine (FT3), white blood cell count, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. In the multivariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age (odds ratio (OR) 1.037 (95% confidence interval (CI) 1.012 - 1.062)), hypertension (OR 0.374 (95% CI 0.203 - 0.689)), FT3 level (OR 0.635 (95% CI 0.412 - 0.980)), LDL (OR 0.643 (95% CI 0.456 - 0.907)) and HDL (OR 0.654 (95% CI 0.465 - 0.919)). There was a high prevalence of DM among patients with TNs. Age, hypertension, FT3, LDL and HDL were significantly associated with DM and TNs.

Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis.

This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS). The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs. Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS1.5. The unnecessary biopsy rate of the 2021 K-TIRADS1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Accuracy of Ultrasound Scans as Compared to Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules.

Thyroid nodules (TNs) are among the more common findings on physical examinations. Due to the fear of the TN harboring malignancy and with the increasing incidence of thyroid cancer, ultrasound (US) scanning is used as an important diagnostic tool in the assessment of a TN. The American College of Radiology's Thyroid Imaging Reporting and Data System (TI-RADS) was established based on specific patterns composed of two or more features. According to the TI-RADS guidelines, a suspicious nodule by US findings should undergo fine-needle aspiration cytology (FNAC), in which results would guide further management. This study was carried out to assess the accuracy ofUS as compared to FNACin the diagnosis of a thyroid nodule. This retrospective study involved 213 cases that were sent for FNAC after having done a US scan of the thyroid. Data was gathered from all patient files that were referred for FNAC thyroid between 01/02/2018 and 30/06/2021 in Al-Ahli Hospital in the state of Qatar. The US scans were interpreted and reported according to the TI-RADS criteria. The FNAC samples were interpreted and reported according to the Bethesda System for Reporting Thyroid Cytopathology. Data were tabulated and analyzed with Excel (Microsoft, Redmond, WA, USA) and SPSS version 25 (IBM Corp., Armonk, NY, USA). The study showed that US had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 73.9%, 72.6%, 24.6% and 95.8%, respectively, with a significant association between the results of US and the results of FNAC (X2 (1, n = 213) = 20.295, p < .001) and a significant positive correlation (phi coefficient = .309, p < .001). In addition, the data showed that the odds for having a positive FNAC were 7.519 (95% CI: 2.811, 20.112) times greater for cases with positive US compared with cases with negative US. The relative risk of having a positive FNAC when the US was positive was 5.913 (95% CI: 2.440, 14.332) times greater compared to when the US was negative. While our results showed that US cannot be solely relied on in diagnosing TNs, they did show that US can reliably rule out a malignancy in TNs. Recent studies have been showing increasing accuracy of US in diagnosing TNs and more studies are needed to explore this topic.

Diagnostic efficiency of existing guidelines and the AI-SONIC™ artificial intelligence for ultrasound-based risk assessment of thyroid nodules.

The thyroid ultrasound guidelines include the American College of Radiology Thyroid Imaging Reporting and Data System, Chinese-Thyroid Imaging Reporting and Data System, Korean Society of Thyroid Radiology, European-Thyroid Imaging Reporting and Data System, American Thyroid Association, and American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines. This study aimed to compare the efficiency of the six ultrasound guidelines vs. an artificial intelligence system (AI-SONICTM) in differentiating thyroid nodules, especially medullary thyroid carcinoma. This retrospective study included patients with medullary thyroid carcinoma, papillary thyroid carcinoma, or benign nodules who underwent nodule resection between May 2010 and April 2020 at one hospital. The diagnostic efficacy of the seven diagnostic tools was evaluated using the receiver operator characteristic curves. Finally, 432 patients with 450 nodules were included for analysis. The American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines had the best sensitivity (88.1%) and negative predictive value (78.6%) for differentiating papillary thyroid carcinoma or medullary thyroid carcinoma vs. benign nodules, while the Korean Society of Thyroid Radiology guidelines had the best specificity (85.6%) and positive predictive value (89.6%), and the American Thyroid Association guidelines had the best accuracy (83.7%). When assessing medullary thyroid carcinoma, the American Thyroid Association guidelines had the highest area under the curve (0.78), the American College of Radiology Thyroid Imaging Reporting and Data System guidelines had the best sensitivity (90.2%), and negative predictive value (91.8%), and AI-SONICTM had the best specificity (85.6%) and positive predictive value (67.5%). The Chinese-Thyroid Imaging Reporting and Data System guidelines had the best under the curve (0.86) in diagnosing malignant tumors vs. benign tumors, followed by the American Thyroid Association and Korean Society of Thyroid Radiology guidelines. The best positive likelihood ratios were achieved by the Korean Society of Thyroid Radiology guidelines and AI-SONICTM (both 5.37). The best negative likelihood ratio was achieved by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines (0.17). The highest diagnostic odds ratio was achieved by the American Thyroid Association guidelines (24.78). All six guidelines and the AI-SONICTM system had satisfactory value in differentiating benign vs. malignant thyroid nodules.

The feasibility of decreasing the thresholds for biopsy in Kwak and C TIRADSs.

To estimate the feasibility of decreasing the original thresholds for biopsy in the Kwak Thyroid Imaging Reporting and Data System (Kwak TIRADS) and Chinese Thyroid Imaging Reporting and Data System (C TIRADS). This retrospective study included 3,201 thyroid nodules from 2,146 patients with a pathological diagnosis. We lowered the original fine-needle aspiration (FNA) thresholds with the TR4a-TR5 in Kwak and C TIRADSs and calculated the ratio of additional benign-to-malignant nodules being biopsied (RABM). If the RABM is less than 1, the decreased FNA thresholds could be accepted and used to the modified TIRADSs (modified C and Kwak TIRADSs). Then, we estimated and compared the diagnostic performance between the modified TIRADS and the original TIRADS to determine if the decreased thresholds could be an effective strategy. A total of 1,474 (46.0%) thyroid nodules were diagnosed as malignant after thyroidectomy. The TR4c-TR5 in Kwak TIRADS and TR4b-TR5 in C TIRADS had a rational RABM (RABM < 1). The modified Kwak TIRADS had higher sensitivity, a positive predictive value, a negative predictive value, lower specificity, an unnecessary biopsy rate, and a missed malignancy rate compared with the original Kwak TIRADS (94.1% vs. 42.6%, 59.4% vs. 44.6%, 89.9% vs. 52.8%, 45.0% vs. 54.9%, 40.6% vs. 55.4%, and 10.1% vs. 47.1%, respectively, P < 0.05 for all). Similar trends were seen in the modified C TIRADS versus the original C TIRADS (95.1% vs. 38.7%, 61.7% vs. 47.8%, 92.3% vs. 55.0%, 49.7% vs. 64.0%, 38.3% vs. 52.2%, and 7.7% vs. 44.9%, respectively, P < 0.05 for all). The biopsy of all nodules with TR4C-TR5 in the Kwak TIRADS and TR4B-TR5 in the C TIRADS might be an effective strategy. This paper contributes to the contradiction concerning whether to perform FNA for the nodules smaller than 10mm.

The TNAPP web-based algorithm improves thyroid nodule management in clinical practice: A retrospective validation study.

The detection of thyroid nodules has been increasing over time, resulting in an extensive use of fine-needle aspiration (FNA) and cytology. Tailored methods are required to improve the management of thyroid nodules, including algorithms and web-based tools. To assess the performance of the Thyroid Nodule App (TNAPP), a web-based, readily modifiable, interactive algorithmic tool, in improving the management of thyroid nodules. One hundred twelve consecutive patients with 188 thyroid nodules who underwent FNA from January to December 2016 and thyroid surgery were retrospectively evaluated. Neck ultrasound images were collected from a thyroid nodule registry and re-examined to extract data to run TNAPP. Each nodule was evaluated for ultrasonographic risk and suitability for FNA. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of TNAPP were calculated and compared to the diagnostic performance of the other two algorithms by the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), which it was derived from the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). TNAPP performed better in terms of sensitivity (>80%) and negative predictive value (68%) with an overall accuracy of 50.5%, which was similar to that found with the AACE/ACE/AME algorithm. TNAPP displayed a slightly better performance than AACE/ACE/AME and ACR TI-RADS algorithms in selectively discriminating unnecessary FNA for nodules with benign cytology (TIR 2 - Bethesda class II: TNAPP 32% vs. AACE/ACE/AME 31% vs. ACR TI-RADS 29%). The TNAPP reduced the number of missed diagnoses of thyroid nodules with suspicious and highly suspicious cytology (TIR 4 + TIR 5 - Bethesda classes V + VI: TNAPP 18% vs. AACE/ACE/AME 26% vs. ACR TI-RADS 20.5%). A total of 14 nodules that would not have been aspirated were malignant, 13 of which were microcarcinomas (92.8%). The TNAPP algorithm is a reliable, easy-to-learn tool that can be readily employed to improve the selection of thyroid nodules requiring cytological characterization. The rate of malignant nodules missed because of inaccurate characterization at baseline by TNAPP was lower compared to the other two algorithms and, in almost all the cases, the tumors were microcarcinomas. TNAPP's use of size >20mm as an independent determinant for considering or recommending FNA reduced its specificity. TNAPP performs well compared to AACE/ACE/AME and ACR-TIRADS algorithms. Additional retrospective and, ultimately, prospective studies are needed to confirm and guide the development of future iterations that incorporate different risk stratification systems and targets for diagnosing malignancy while reducing unnecessary FNA procedures.

Comparison of S-Detect and thyroid imaging reporting and data system classifications in the diagnosis of cytologically indeterminate thyroid nodules.

The aim of this study was to investigate the value of S-Detect for predicting the malignant risk of cytologically indeterminate thyroid nodules (CITNs). The preoperative prediction of 159 CITNs (Bethesda III, IV and V) were performed using S-Detect, Thyroid Imaging Reporting and Data System of American College of Radiology (ACR TI-RADS) and Chinese TI-RADS (C-TIRADS). First, Linear-by-Linear Association test and chi-square test were used to analyze the malignant risk of CITNs. McNemar's test and receiver operating characteristic curve were used to compare the diagnostic efficacy of S-Detect and the two TI-RADS classifications for CITNs. In addition, the McNemar's test was used to compare the diagnostic accuracy of the above three methods for different pathological types of nodules. The maximum diameter of the benign nodules was significantly larger than that of malignant nodules [0.88(0.57-1.42) vs 0.57(0.46-0.81), P=0.002]. The risk of malignant CITNs in Bethesda system and the two TI-RADS classifications increased with grade (all P for trend<0.001). In all the enrolled CITNs, the diagnostic results of S-Detect were significantly different from those of ACR TI-RADS and C-TIRADS, respectively (P=0.021 and P=0.007). The sensitivity and accuracy of S-Detect [95.9%(90.1%-98.5%) and 88.1%(81.7%-92.5%)] were higher than those of ACR TI-RADS [87.6%(80.1%-92.7%) and 81.8%(74.7%-87.3%)] (P=0.006 and P=0.021) and C-TIRADS [84.3%(76.3%-90.0%) and 78.6%(71.3%-84.5%)] (P=0.001 and P=0.001). Moreover, the negative predictive value and the area under curve value of S-Detect [82.8% (63.5%-93.5%) and 0.795%(0.724%-0.855%)] was higher than that of C-TIRADS [54.8%(38.8%-69.8%) and 0.724%(0.648%-0.792%] (P=0.024 and P=0.035). However, the specificity and positive predictive value of S-Detect were similar to those of ACR TI-RADS (P=1.000 and P=0.154) and C-TIRADS (P=1.000 and P=0.072). There was no significant difference in all the evaluated indicators between ACR TI-RADS and C-TIRADS (all P>0.05). The diagnostic accuracy of S-Detect (97.4%) for papillary thyroid carcinoma (PTC) was higher than that of ACR TI-RADS (90.4%) and C-TIRADS (87.8%) (P=0.021 and P=0.003). The diagnostic performance of S-Detect in differentiating CITNs was similar to ACR TI-RADS and superior to C-TIRADS, especially for PTC.

Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics.

Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet's AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. On a scale from 0.0 to 1.0, the Gwet's AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases. Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.

Detection of driver mutations in plasma cell-free nucleic acids in differentiated thyroid neoplasm.

This proof-of-concept paper demonstrates that driver mutations can be detected in plasma in differentiated thyroid tumors, and we were able to detect mutations in upto 80% malignant thyroid nodules. Additionally, cancer subtypes could also be predicted using a 8-gene panel. In almost 90% follicular adenoma, rat sarcoma virus (RAS) mutations were detectable. There was a strong agreement between driver mutations found in plasma samples, FNAC materials, and histopathology samples. This has potential as a noninvasive, preoperative diagnostic tool (particularly of clinical importance in indeterminate nodules) and may help in detection of residual tumor after surgery. Future research is warranted to test the role of this tool to detect tumor recurrence. Ultrasonographic (USG) evaluation and fine-needle aspiration (FNA) are cornerstone for evaluation of thyroid neoplasm. Molecular technique including detection of driver mutation from FNA cytology (FNAC) material is an established modality. In this study, we explored the feasibility of using plasma cell-free nucleic acids to identify known driver mutations in differentiated thyroid neoplasm. Patients presenting with thyroid nodules underwent USG with Thyroid Image Reporting and Data Systems scoring and FNAC (Bethesda classification). All patients in Bethesda 3, 4, 5, 6 underwent surgery and histopathological confirmation. Patients in Bethesda 2 (cosmetic concerns, compressive symptoms) underwent surgery, and rest were presumed benign on the basis of USG, FNAC features, and clinical followup.). Endocrinology clinic. Subjects with thyroid nodule. None. Plasma sample, FNA, and histopathology material were evaluated for driver mutations (8-gene panel comprising BRAF-V600E, RET/PTC3, RET/PTC1, TERT promoter, HRAS, NRAS, KRAS, and PAX8-PPARG). A total of 223 subjects were recruited; of these 154 were benign and 69 had differentiated thyroid cancer. We were able to detect driver mutation from plasma in 55 subjects (79.71%) of all malignant patients, and 11 patients in benign category had RAS mutation (follicular adenoma). Rest of the benign nodules did not have any detectable driver mutations. Plasma might be a viable noninvasive alternative source for detection of driver mutations (8-gene panel) in subjects with differentiated thyroid tumors and may have significant clinical utility.

Development of a machine learning-based fine-grained risk stratification system for thyroid nodules using predefined clinicoradiological features.

We constructed and validated a machine learning-based malignancy risk estimation model using predefined clinicoradiological features, and evaluated its clinical utility for the management of thyroid nodules. In total, 5708 benign (n = 4597) and malignant (n = 1111) thyroid nodules were collected from 5081 consecutive patients treated in 26 institutions. Seventeen experienced radiologists evaluated nodule characteristics on ultrasonographic images. Eight predictive models were used to stratify the thyroid nodules according to malignancy risk; model performance was assessed via nested 10-fold cross-validation. The best-performing algorithm was externally validated using data for 454 thyroid nodules from a tertiary hospital, then compared to the Thyroid Imaging Reporting and Data System (TIRADS)-based interpretations of radiologists (American College of Radiology, European and Korean TIRADS, and AACE/ACE/AME guidelines). The area under the receiver operating characteristic (AUROC) curves of the algorithms ranged from 0.773 to 0.862. The sensitivities, specificities, positive predictive values, and negative predictive values of the best-performing models were 74.1-76.6%, 80.9-83.4%, 49.2-51.9%, and 93.0-93.5%, respectively. For the external validation set, the ElasticNet values were 83.2%, 89.2%, 81.8%, and 90.1%, respectively. The corresponding TIRADS values were 66.5-85.0%, 61.3-80.8%, 45.9-72.1%, and 81.5-90.3%, respectively. The new model exhibited a significantly higher AUROC and specificity than did the TIRADS risk stratification, although its sensitivity was similar. We developed a reliable machine learning-based predictive model that demonstrated enhanced specificity when stratifying thyroid nodules according to malignancy risk. This system will contribute to improved personalized management of thyroid nodules. • The area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity of our model were 0.914, 83.2%, and 89.2%, respectively (derived using the validation dataset). • Compared to the TIRADS values, the AUROC and specificity are significantly higher, while the sensitivity is similar. • An interactive version of our AI algorithm is at http://tirads.cdss.co.kr .

American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology: which one is better at predicting malignancy risk?

The aim of this study was to compare the capacity of American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology in predicting malignancy risk of thyroid nodules and to verify which one is better at avoiding unnecessary fine needle aspiration. This was a cross-sectional study with 565 thyroid nodules, followed at a tertiary care hospital, in an iodine-replete area. Those were classified as American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology systems and stratified according to the Bethesda classification of fine needle aspiration. The values of sensibility, specificity, positive predictive value, and negative predictive value accuracy were calculated. Also, the percentage of unnecessary biopsies was presented. The mean age of the individuals was 58.2±13.5 [26-90] years for benign nodules and 41.7±15.6 [23-66] years for malignant nodules (p=0.002). Regarding gender, 92.6% (n=150) of the individuals with benign nodules and 85.7% (n=06) with malignant nodules were females (p=0.601). For American Thyroid Association, 90.9% of sensibility, 51.4% of specificity, 52.6% of accuracy, 10.2% of positive predictive value, and 98.9% of negative predictive value were found. For Thyroid Imaging Reporting and Data System developed by the American College of Radiology, 90.9% of sensibility, 49.7% of specificity, 52.1% of accuracy, 9.9% of positive predictive value, and 98.9% of negative predictive value were found. .Notably, 12.3% of unnecessary fine needle aspiration were found in American Thyroid Association and 44.4% were found in Thyroid Imaging Reporting and Data System developed by the American College of Radiology. Both Thyroid Imaging Reporting and Data System developed by the American College of Radiology and American Thyroid Association are able to predict the malignancy risk of thyroid nodules. Thyroid Imaging Reporting and Data System developed by the American College of Radiology was better at avoiding unnecessary fine needle aspiration.

Prevalence and Associated Predictors of Hypertension in Adult Patients with Thyroid Nodules at the Royal Commission Hospital, Kingdom of Saudi Arabia.

Hypertension and thyroid nodules (TNs) are common medical problems that are increasing in prevalence globally. Hence, we conducted this study to assess the prevalence and associated predictors of hypertension in adult patients with TNs at the Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). A retrospective study was conducted between 1 January 2015 and 31 December 2021. Patients with documented TNs based on the Thyroid Imaging Reporting and Data System (TI-RADS) were recruited to assess the prevalence and associated risk factors for hypertension. Three hundred ninety-one patients with TNs were recruited for this study. The median (interquartile range, IQR) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. The median (IQR) body mass index (BMI) was 30.26 (7.71) kg/m2. There was a high prevalence of hypertension (22.5%) in adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed hypertension in patients with TNs and age, sex, diabetes mellitus (DM), bronchial asthma, triiodothyronine (FT3), total cholesterol and high-density lipoprotein (HDL). In the multivariate analysis, age (OR = 1.076 [95% CI 1.048 - 1.105]), sex (OR = 2.28 [95% CI 1.132 - 4.591]), DM (OR = 0.316 [95% CI 0.175 - 0.573]) and total cholesterol levels (OR = 0.820 [95% CI 0.694 - 0.969]) were significantly associated with hypertension. There is a high prevalence of hypertension in patients with TNs. Age, female sex, DM and elevated total cholesterol are significant predictors of hypertension in adult patients with TNs.

Accuracy of American College of Radiology Thyroid Imaging Reporting and Data System in Characterisation of Thyroid Nodules: A Tertiary Hospital Study in India

Background: Thyroid nodules (TNs) are commonly and frequently encountered in the day-to-day clinical practice. Clinical suspicion of malignancy as well as patient anxiety is the frequent reasons for fine-needle aspiration cytology or biopsy (FNAC/B) of TN. American College of Radiology has developed a Thyroid Imaging Reporting and Data System (ACR TI-RADS) based on TN ultrasound features to suggest malignancy to minimise the number of TN subjected to FNAC/B. Aim to assess the diagnostic accuracy of ACR TI-RADS in our Tertiary Hospital Health Facility. Patients, Materials and Methods: Sixty-nine patients with TN included in our study following institutional ethics committee approval and written informed consent underwent high-resolution ultrasonography followed by FNAC using a high-frequency linear transducer on Siemen Acuson S3000 ultrasound scanner. The data were recorded in the predesigned proforma followed by statistical analysis to assess the diagnostic accuracy of ACR TI-RADS. Results: Our study had female predominance (50/69) with the left side more commonly affected (37/69). The mean age of the participants was 42.2 ± 15.6 years with significantly higher age at presentation in those with malignant TN. Mixed nodules were predominant (46/69) with nearly half of the malignant nodules being solid and only 8/61 benign nodules being solid. Although the majority of the nodules were hyperechoic (50/69 including 2 malignant), a significant number of the hypoechoic/very hypoechoic nodules (6/14) were malignant with only 8/61 benign nodules being hypoechoic. Half of the malignant nodules (4/8) had lobulated or ill-defined margins, whereas only 2/61 benign nodules had similar margins. The majority (5/8) of the malignant TN had internal punctate echogenic foci with only 1/61 benign TN showing similar appearance. Half of the malignant TN (4/8) had lymphadenopathy, whereas it was noted in only 2/61 cases of benign TN. Conclusions: TNs though have a high prevalence, but malignant TNs are uncommon with majority being solid, taller than wider, hypoechoic with microcalcifications. The presence of adenopathy is usually a feature of malignant thyroid nodule rarely seen with benign nodules. Thus, to summarise all TNs should be thoroughly evaluated as per ACR TI-RADS for stratification of risk of malignancy.

The Diagnostic Value of BRAF V600E Gene Detection Combined with DNA Ploidy Analysis in Thyroid Cancer.

The thyroid cancer incidence has been experimenting an accelerated growth all over the world. The serine/threonine-protein kinase (BRAF) V600E gene detection or the DNA ploidy analysis has been employed in the identification of thyroid cancer type. This study aimed to evaluate the diagnostic value of the BRAF V600E gene integrated with DNA ploidy analysis in thyroid cancer. From August 2022 to May 2023, 400 individuals from the thyroid surgery outpatient department of our hospital were enrolled in this study. The participants were divided into low-risk groups (Ⅰ+Ⅱ+Ⅲ group; n = 200) and high-risk groups (Ⅳ+Ⅴ group; n = 200) based on the Thyroid Imaging Reporting and Data System (TI-RADS). A total of the patients were subjected to the DNA ploidy analysis, the BRAF V600E gene detection, or the combination of both techniques. We evaluated the diagnostic value of the above techniques and considered the postoperative pathology results as gold standard for cancer diagnosis. The negative predictive value (NPV), accuracy, specificity, sensitivity, and positive predictive value (PPV) of TI-RADS, BRAF V600E gene detection, DNA ploidy analysis, and BRAF V600E gene detection joined with DNA ploidy analysis were calculated. Among 400 subjects, 238 presented thyroid cancer and 162 had benign lesions, according to the postoperative pathology results. The obtained sensitivity, specificity, accuracy, PPV, and NPV values of TI-RADS were 55.88%, 58.64%, 57.00%, 66.50%, 47.50%, respectively; of BRAF V600E gene detection were 81.93%, 69.75%, 77.00%, 79.92%, 72.44%, respectively; of DNA ploidy analysis were 83.19%, 72.84%, 79.00%, 81.82%, 74.68%, respectively; of BRAF V600E gene combined with DNA ploidy analysis were 90.34%, 76.54%, 84.75%, 84.98%, 84.35%, respectively. Compared with TI-RADS, the sensitivity, specificity, accuracy, PPV, and NPV values of DNA ploidy analysis, BRAF V600E gene detection, and the conjunction of these last two methods were increased (p < 0.05). The combination of DNA ploidy analysis and BRAF V600E gene detection had the highest values among them all. BRAF V600E gene detection in conjunction with DNA ploidy analysis showed a better diagnostic value than both methods separately or TI-RADS.

Radio-Pathological Correlation of Suspected Malignant Thyroid Nodules using Elastography strain ratio and Bethesda Classification for Thyroid Cytopathology

Objectives: To determine the diagnostic performance of elastography strain ratio (SR) for the diagnosis of malignant thyroid nodules taking fine needle aspiration cytology (FNAC) as the gold standard at a tertiary care hospital in Pakistan. Methods: This is a cross-sectional study. A total of 150 cases aged 20-60 years, of either gender, who presented with palpable/suspected malignant thyroid nodules of any size with Thyroid Imaging Reporting and Data System (TIRADS) category 3 or above on ultrasonography were included. These were further evaluated by elastography and ultrasoundguided fine needle aspiration cytology (FNAC). The elastography SR of the nodules was assessed. Final diagnosis was made using ultrasound-guided FNAC. Relevant clinical and demographic data were obtained from patient charts. The diagnostic sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated for elastography using FNAC as a gold standard. Results: The mean age of all patients was 41.8±8.6 years (range: 20-60 years). There were 97 (64.67%) males and 53 (35.33%) females. The majority of patients, 50 (33.33%), belonged to age category of 41 to 50 years. Taking elastography SR of > 2.32 as the cut-off, 69 (46.0%) nodules were positive, and 81 (54.0%) were negative. The FNAC results showed that 72 (48.0%) were positive, and 78 (52.0%) were negative. The diagnostic sensitivity of SR was 92.31%, specificity, 87.50%, positive predictive value, 88.89% and negative predictive value was 91.30%. The overall diagnostic accuracy was estimated to be 87.5%. Conclusion: The results from this study show that elastography and SR are highly valuable in discriminating benign from malignant thyroid nodules. These may serve as an affordable and reliable alternative diagnostic technique, particularly in the developing world. Keywords: Bethesda system for thyroid cytopathology, elastography, strain ratio, thyroid incidentalomas, thyroid nodules

Retracted: The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI‐RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

Retracted: The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI‐RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

Diagnostic Value of Applying ACR-TIRADS on Thyroid Nodule Biopsies at a Tertiary Care Centre in the United Arab Emirates: A Prospective Observational Study

Introduction: Incidental thyroid nodules are commonly encountered in clinical practice, and only a minority of these are malignant. Suspicious nodules on ultrasound are subjected to Fine Needle Aspiration Biopsy (FNAB) to rule out malignancy and determine appropriate management. In the United Arab Emirates, medical professionals from various countries practice, and there are no well-established local best practice guidelines for thyroid nodule biopsies. Aim: To determine the percentage of thyroid nodules in which FNAB would be considered unnecessary by applying the American College of Radiology (ACR)-Thyroid Imaging Reporting and Data System (TIRADS) 2017 guidelines. Materials and Methods: A prospective observational study was conducted in the Radiology Department of Belhoul Speciality Hospital, Dubai, United Arabs Emirates from January 2018 to December 2019. A total of 142 thyroid nodules were studied, and FNABs were performed. Two experienced radiologists assigned ACR-TIRADS categories to the nodules. The nodules were divided into groups: Fine-Needle Aspiration (FNA) indicated and FNA not indicated. Surgically resected nodules underwent histopathological examination, and benign or malignant categorisation was based on histopathological findings. Cases with Bethesda II cytology were considered benign, Bethesda V and VI were considered malignant, and 35 cases with Bethesda I, III, or IV cytology were excluded from the study. The final study cohort included 107 nodules with available final reference standard diagnoses. Data were analysed using International Business Machine Statistical Package for Social Sciences (IBM SPSS) Statistics 26.0, and sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Diagnostic Odds Ratio (DOR) {each with 95% Confidence Interval (CI)} were calculated. Results: Out of the 107 nodules included in the study, 15 (14%) were malignant, and 92 (86%) were benign. Applying ACRTIRADS, biopsy was not indicated in 54 out of 107 patients, resulting in an “unnecessary” biopsy rate of 50.5%. Only two out of the 15 malignant cases were assigned to the FNAC not indicated group due to their subcentimetre size. Therefore, the sensitivity, NPV, and false negative rate of these criteria were 86.7%, 96.3%, and 3.7%, respectively. Conclusion: The ACR-TIRADS guidelines are highly reliable, and if strictly followed, almost half of thyroid nodule biopsies can be safely avoided. However, since ACR-TIRADS does not recommend FNA for subcentimetre thyroid nodules, a few small malignancies may experience delayed diagnosis.

Association between American College of Radiology Thyroid Imaging Reporting and Data System and Bethesda Scoring System in Assessment of Thyroid Nodule: A Prospective Cross-sectional Study

Introduction: In view of increased detection of incidental thyroid nodules on ultrasonography, there is a need for standardising the reporting system of thyroid nodules for better patient management. Aim: To assess concordance between two classification systems of thyroid nodules: American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) 2017 criteria on sonography and Bethesda categories on cytology. Materials and Methods: A prospective, cross-sectional validation study was conducted in Department of Radiology in collaboration with the Department of Pathology at a tertiary care hospital in Dakshina Kannada district, Karnataka, India, over a period of 12 months between October 2017 to September 2018. A total of 175 thyroid nodules detected on Ultrasonography (USG) were categorised based on ACR TIRADS 2017 criteria. Ultrasound guided Fine Needle Aspiration Cytology (FNAC) was performed on the nodules and were scored on the basis of Bethesda categories. Nodules were categorized into benign and malignant under TIRADS and Bethesda and their concordance was assessed. Sensitivity, specificity, positive and negative predictive value were assessed. Pearsons Chi-square test statistical method and kappa values were used in analysis. Results: Solid composition, hypoechoic echotexture, taller than wide shape, irregular margin and microcalcification descriptors of ACR TIRADS 2017 system were features more in favour of a malignant nodule. With FNAC as gold standard, TIRADS had a sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of 91.7 %, 86.3%, 63.5%, 97.6% and 87.4% respectively (p-value &lt;0.001). Conclusion: The stratification of risk among thyroid nodules as benign or malignant using ACR TIRADS 2017 criteria yielded good result in our study. With careful examination of nodules, TIRADS can be used to select appropriate nodules for further evaluation with cytology.

Clinical Application of the 2021 Korean Thyroid Imaging Reporting and Data System (K-TIRADS)

In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is a pattern-based, US malignancy risk stratification system that can easily diagnose nodules during real-time ultrasound examinations. The 2021 K-TIRADS clarified the US criteria for nodule classification and revised the size thresholds for nodule biopsy, thereby reducing unnecessary biopsies for benign nodules while maintaining the appropriate sensitivity to detect malignant tumors in patients without feature of high risk thyroid cancer. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care.