TI-RADS Classification Research Articles

Usefulness of Color Doppler Ultrasonography in the Risk Stratification of Thyroid Nodules

Introduction: Thyroid ultrasound (US) is crucial for clinical decision in the management of thyroid nodules. In this cross-sectional study, we aimed to test if the evaluation of thyroid nodules’ vascularization could improve the risk stratification ability of the American College of Radiology (ACR) TI-RADS classification system. Methods: A total of 873 thyroid nodules undergoing fine-needle aspiration were classified according to ACR TI-RADS US classification. Three types of vascularization were identified: type 0, no vascular signals; type 1, peripheral vascular signals; type 2, peripheral and intralesional vascular signals. Cytology specimens were evaluated conforming to the Italian Reporting System for Thyroid Cytology, and TIR3b, TIR4, and TIR5 were defined as high risk for malignancy. Odds ratios (ORs) with 95% confidence intervals (CI) and the areas under the receiver operating characteristic curves (ROC-AUC) for high-risk cytology categories were calculated. Results: The 3 vascular patterns were differently distributed within the cytology categories: 52.4% of TIR1c, 15.9% of TIR2, 5.9% of TIR3a, 6.7% of TIR3b, 12.5% of TIR4, and 28.9% of TIR5 nodules had no vascular signals (p < 0.001). Nodule vascularity alone was not associated with a higher risk of malignant cytology (OR [95% CI] 0.75 [0.43–1.32], p = 0.32), without differences between peripheral (OR [95% CI] 0.65 [0.35–1.20]) and intranodular (OR [95% CI] 0.88 [0.48–1.62]) vascularization (p = 0.22). The ROC-AUC (95% CI) for the diagnosis of malignant cytology was similar when considering TI-RADS classification alone (0.736 [0.684–0.786]) and when considering TI-RADS classification plus the presence/absence of vascular signals (0.736 [0.683–0.789], p value for differences between the ROC-AUCs: 0.91). Among TR1, TR2, and TR3 TI-RADS classes, no nodules without vascular signals showed a malignant cytology, allowing the identification of nodules with benign cytology with 100% specificity within these US classes. Conclusions: Color Doppler study of thyroid nodules does not improve the risk stratification ability of the ACR TI-RADS US classification system.

Obesity and Waist Circumference are Possible Risk Factors for Thyroid Cancer: Correlation with Different Ultrasonography Criteria.

BackgroundObesity has an important role in the pathogenesis of cancer; however, there are no clear mechanisms explaining the association between obesity and risk of thyroid cancer (TC).MethodsIt is a cross-sectional study including 184 patients with benign thyroid nodules (BN) and 19 patients with TC. Body mass index (BMI), waist circumference (WC), hip circumference (HC), waist/hip (W/H) ratio were assessed and correlated to relevant clinico-pathological features of the patients, different ultra-sonographic (U/S) criteria and risk of malignancy.ResultsThere was a significant increase in BMI, WC and W/H ratio in TC patients compared to BN group (P=0.001, 0.011 and 0.003). Increased BMI, WC and HC were associated significantly with solid nodules (P<0.05). WC increased in hypoechoic (103.1±15.4cm) and heterogeneous (103.8±16.7cm) nodules, compared to isoechoic (97.3±15.5cm) and hyperechoic (96.1±10cm) nodules (P=0.046). It also increased with lymph nodes enlargement (P=0.04). There was a significant association between WC and TIRADS classification (P=0.032), as it increased with TR4b (118.5 ± 12.9 cm) and TR5 (117.3 ± 13.9 cm) compared to TR2 (114.1 ± 15.7 cm, P=0.025 and 0.008, respectively). WC is an independent predictor for TC [OR: 1.092, CI: 1.020–1.170, P=0.012]. It achieved sensitivity, specificity and AUC (71.4%, 68.7% and 0.750; respectively), at a cutoff value of 108.5 cm (P=0.003), and when combined with BMI at a cutoff value of 32.59 (77.8% and 68.4%, respectively, AUC: 0.780, P<0.001).ConclusionCentral adiposity is strongly associated with the risk of TC. WC is more superior to BMI when correlated with TIRADS classification and also is an independent predictor for TC.

Updated ACR Thyroid Imaging Reporting and Data Systems in risk stratification of thyroid nodules: 1-year experience at a Tertiary Care Hospital in Al-Qassim

BackgroundThyroid imaging reporting and data system (TI-RADS) is assessment of risk stratification of thyroid nodules, using a score. A novel ACR (American College of Radiology) TI-RADS has been recently suggested by American College of Radiology. But, the utility of ACR TI-RADS in risk stratification for thyroid lesion needs further evaluation.AimOf this study was to evaluate ACR TI-RADS classification in discriminating benign and from other thyroid lesions as detected by fine needle aspiration cytology (FNAC).MethodsThis retrospective study included all patients referred to our institute for FNAC of a thyroid nodule over 1 year. Thyroid nodules were categorized according to the 2017 ACR TI-RADS. Ultimately, efficacy of ACR TI-RADS in differentiating benign from non-benign nodules was assessed using ROC curve, cross-tabulation, and Chisquare tests. According to the results of FNAC, nodules were classified into 2 groups; benign lesions (Bethesda II) and malignant lesions (Bethesda IV, V).ResultsThe percentages of Bethesda IV and V lesions defined in our ACR-TIRADS were as follows: ACR TI-RADS 1, 2 (0%), ACR TI-RADS 3 (4%), ACR TI-RADS 4 (6.6%), and ACR TI-RADS 5 (22.6%). ROC curve analysis for ACR TI-RADS to differentiate benign from non-benign pathology showed (AUC 0.60, 95% CI: 0.505–0.713). ACR TI-RADS had sensitivity, specificity, positive predictive value and negative predictive value 75%, 62.35 %, 15.7%, 96.3% respectively.ConclusionDifferentiation between benign and malignant thyroid lesion can be suggested from the ultrasound based ACR TI-RADS system. FNAC might be deferred in patients having ACR TI-RADS 1 and 2.

Tirads classification and final diagnosis of thyroid nodules classified as bethesda-3 after fine-needle aspiration

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Ultrasonographic and clinical pathological features of intrathyroid thymic carcinoma

Objective To investigate the ultrasonographic and clinical pathological features of intrathyroid thymic carcinoma(ITTC). Methods The ultrasonographic and clinical pathological features of 11 cases of pathologically confirmed intrathyroid thymic carcinoma were analyzed retrospectively. The size, shape, boundary, internal echo, calcification, cystic change, blood flow of the lesion and lymph nodes of the neck were recorded. TI-RADS classification was performed on the lesion, and the medical history, clinical symptoms and treatment process of the patients were recorded. Results The lesions of all 11 patients were solid and located in the lower pole or middle-lower part of the thyroid, 8 cases were located in the right lobe of the thyroid gland (8/11, 72.7%), and 3 cases were located in the left lobe (3/8, 27.3%). The maximum diameter diameter of the lesions was (3.55±0.51)cm. All the lesions were hypoechogenicity or marked hypoechogenicity and ill-defined margin. The internal echo of the lesions were heterogeneous. Ten lesions were characterized by striped hyperechogenicity interiorly on ultrasonograms. According to TI-RADS classification, 2 cases were class 4a, 3 cases were class 4b, 2 cases were class 4c and 4 cases were class 5. There was no cystic component or calcifcation in all lesions, and there was no taller-than-wide shape. Three of 11 cases were accompanied by Hashimoto′s thyroiditis. Postoperative pathology showed that 5 cases had cervical lymph node metastasis, 5 had perithyroidal soft tissue in ltration, of them, 3 cases had recurrent laryngeal nerve, 2 cases invaded the esophageal wall, and 3 cases invaded the striated muscle of the neck. Immunohistochemistry showed that CD5 and CD117 of all lesions were positive. All patients underwent surgery, and 3 of them underwent radiotherapy and chemotherapy after surgery. Conclusions There are common sonographic features of intrathyroid thymic carcinoma, which are located at the lower pole or middle-lower of the thyroid gland, presenting a solid hypoechogenicity or marked hypoechogenicity, with ill-defined margin and striped hyperechogenicity interiorly on ultrasonograms. These sonographic features are helpful for the diagnosis of ITTC. Key words: Ultrasonography; Intrathyroid thymic carcinoma; Pathology

Value of conventional ultrasound combined with contrast-enhanced ultrasound in differential diagnosis of thyroid TI-RADS 3-5 nodules

Objective To evaluate the diagnostic value of gray-scale ultrasound combined with contrast-enhanced ultrasound (CEUS) in thyroid imaging and reporting system (TI-RADS) 3-5 nodules of American College of Radiology (ACR). Methods The 208 patients(216 nodules) who underwent thyroid contrast-enhanced ultrasound examination from April 2014 to December 2016 were retrospectively analyzed. The ACR TI-RADS classification and contrast-enhanced mode of thyroid ultrasound were evaluated. The benign and malignant thyroid lesions were constructed through the analysis of contrast-enhanced mode of thyroid benign and malignant lesions in the past literature and the preliminary study of our group. Prediction model of gray scale combined with contrast-enhanced ultrasound for lesions were established. Besides, the sensitivity, specificity and accuracy of gray scale ultrasound combined with contrast-enhanced ultrasound prediction model for differential diagnosis of benign and malignant thyroid lesions were calculated based on the results of puncture biopsy or surgical pathology as the gold standard. Results Compared with pathological results, the positive predictive value, negative predictive value, accuracy, sensitivity and specificity of gray scale combined with contrast-enhanced ultrasound in evaluating thyroid nodules were 90.8%, 93.3%, 91.2%, 98.8% and 62.2%, respectively. Conclusions Gray-scale ultrasound combined with contrast-enhanced ultrasound can provide clinical value in differential diagnosis of benign and malignant TI-RADS 3-5 thyroid nodules. Key words: Contrast-enhanced ultrasound; Thyroid nodule; Thyroid imaging reporting and data system

Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females

BackgroundA higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. MethodsIncluded were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. ResultsOf the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. ConclusionsA referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

Evaluation of the Nature of Thyroid Nodules by Duplex Ultrasound and Assessment of the Diagnostic Accuracy of TIRADS Classification

Evaluation of the Nature of Thyroid Nodules by Duplex Ultrasound and Assessment of the Diagnostic Accuracy of TIRADS Classification

The value of contrast-enhanced ultrasonography in differential diagnosis of thyroid microcarcinoma of TI-RADS grade 3-4

Objective To provide a reference for differential diagnosis of thyroid microcarcinoma classified as TI-RADS 3-4 grade using contrast-enhanced ultrasound. Methods SonoLiver software was used to analyze the process of contrast-enhanced ultrasound of 112 thyroid small nodules classified as TI-RADS 3-4 grade. The dynamic vascular pattern curve (DVPC) and the time-intensity curve (TIC) were automatically acquired for summarization of the types and characteristics of the two curves. The relevant parameters such as the rise time (RT), time to peak (TTP), maximum intensity (IMAX%), mean transit time (mTT), area under curve (AUC) and perfusion index (PI) were acquired and calculated using the software. Receiver operating curve (ROC) analysis was used to achieve the cut-off value of these parameters for differential diagnosis. Results For thyroid microcarcinoma which TI-RADS assessment of grade 3-4, TIC showed as slow rise and slow drop wave or slow rise and fast drop wave, DVPC showed negative waveform or negative-positive bi-directional waveform. ROC analysis demonstrated that IMAX of 96.5%, AUC of 443.08 and PI of 47.64 were the best cut-off values for the differential diagnosis of benign and malignant nodules. When IMAX<96.5%, AUC<443.08, PI<47.64, the nodules were highly likely to be thyroid microcarcinoma. Conclusions The contrast-enhanced ultrasound parameters can provide effective reference for the differential diagnosis of thyroid carcinoma with grade 3-4 in TI-RADS classification. Key words: Contrast-enhanced ultrasonography; Thyroid microcarcinoma; TI-RADS; Time-intensity curve; Dynamic vascular pattern

Correlation Between Simultaneous Ultrasound-Guided Fine Needle Aspiration and Core Needle Biopsy Results in Thyroid Nodules of 44 Cases

Ultrasound (US)-guided fine needle aspiration biopsy (FNA) is currently the most common diagnostic method for determining surgical cases and preventing unnecessary surgery as it is easy, reliable and cost-effective. However, current multi-center studies indicate that about 5-47% of the cases that have undergone FNA are evaluated as inadequate/indeterminate for diagnosis due to factors related to the assessor, the technique and the pathologist's experience. It is reported that using US-guided percutaneous core needle biopsy (CNB) is useful, especially in cases where diagnostic surgery is planned as the cases have been reported as ‘Inadequate for diagnosis’ or ‘Atypia with unclear in significance/ Follicular lesion with unclear in significance(AUS/FLUS) after inadequate repetitive FNA results. Using FNA and CNB together has been reported to provide higher diagnostic sensitivity than either method alone in certain studies. The aim of this study is prospective evaluation of simultaneous US-guided FNA and CNB results of 44 cases who had thyroid nodules. All cases were evaluated according to the TIRADS classification used for sonographic malignancy risk categorization and recorded together with the demographic data (age/gender). FNAs were evaluated according to the Bethesda classification. We tried to adapt the results of the evaluated CNBs descriptively to the Bethesda classification to facilitate comparison of the methods. In our study, when the inadequate and indeterminate diagnosis groups were separated, all our cases diagnosed as benign and malignant with FNA and CNB were compliant. However, the ratio of insufficiency shows a significant elevation compared to CNB in our FNA procedures (4.54% vs. 43.18%). We observed that simultaneous FNA and CNB use decreased the inadequate/ indeterminate diagnosis group significantly.