Unnecessary Fine Needle Aspiration Biopsy Research Articles

Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study.

This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

Dual-modal radiomics nomogram based on contrast-enhanced ultrasound to improve differential diagnostic accuracy and reduce unnecessary biopsy rate in ACR TI-RADS 4–5 thyroid nodules

BackgroundAmerican College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS, TR) 4 and 5 thyroid nodules (TNs) demonstrate much more complicated and overlapping risk characteristics than TR1-3 and have a rather wide range of malignancy possibilities (> 5%), which may cause overdiagnosis or misdiagnosis. This study was designed to establish and validate a dual-modal ultrasound (US) radiomics nomogram integrating B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) imaging to improve differential diagnostic accuracy and reduce unnecessary fine needle aspiration biopsy (FNAB) rates in TR 4–5 TNs.MethodsA retrospective dataset of 312 pathologically confirmed TR4-5 TNs from 269 patients was collected for our study. Data were randomly divided into a training dataset of 219 TNs and a validation dataset of 93 TNs. Radiomics characteristics were derived from the BMUS and CEUS images. After feature reduction, the BMUS and CEUS radiomics scores (Rad-score) were built. A multivariate logistic regression analysis was conducted incorporating both Rad-scores and clinical/US data, and a radiomics nomogram was subsequently developed. The performance of the radiomics nomogram was evaluated using calibration, discrimination, and clinical usefulness, and the unnecessary FNAB rate was also calculated.ResultsBMUS Rad-score, CEUS Rad-score, age, shape, margin, and enhancement direction were significant independent predictors associated with malignant TR4-5 TNs. The radiomics nomogram involving the six variables exhibited excellent calibration and discrimination in the training and validation cohorts, with an AUC of 0.873 (95% CI, 0.821–0.925) and 0.851 (95% CI, 0.764–0.938), respectively. The marked improvements in the net reclassification index and integrated discriminatory improvement suggested that the BMUS and CEUS Rad-scores could be valuable indicators for distinguishing benign from malignant TR4-5 TNs. Decision curve analysis demonstrated that our developed radiomics nomogram was an instrumental tool for clinical decision-making. Using the radiomics nomogram, the unnecessary FNAB rate decreased from 35.3 to 14.5% in the training cohort and from 41.5 to 17.7% in the validation cohorts compared with ACR TI-RADS.ConclusionThe dual-modal US radiomics nomogram revealed superior discrimination accuracy and considerably decreased unnecessary FNAB rates in benign and malignant TR4-5 TNs. It could guide further examination or treatment options.

Ultrasound radiomics based XGBoost model to differential diagnosis thyroid nodules and unnecessary biopsy rate: Individual application of SHapley additive exPlanations.

Radiomics-based eXtreme gradient boosting (XGBoost) model was developed to differentiate benign thyroid nodules from malignant thyroid nodules and to prevent unnecessary thyroid biopsies, including positive and negative effects. The study evaluated a data set of ultrasound images of thyroid nodules in patients retrospectively, who initially received ultrasound-guided fine-needle aspiration biopsy (FNAB) for diagnostic purposes. According to ACR TI-RADS, a total of five ultrasound feature categories and the maximum size of the nodule were determined by four radiologists. A radiomics score was developed by the LASSO algorithm from the ultrasound-based radiomics features. An interpretative method based on Shapley additive explanation (SHAP) was developed. XGBoost was compared with ACR TI-RADS for its diagnostic performance and FNAB rate and was compared with six other machine learning models to evaluate the model performance. Finally, 191 thyroid nodules were examined from 177 patients. The radiomics score were calculated using 8 features, which were selected among 789 candidate features generated from the ultrasound images. The model yielded an AUC of 93% in the training cohort and 92% in the test cohort. It outperformed traditional machine learning models in assessing the nature of thyroid nodules. Compared with ACR TI-RADS, the FNAB rate decreased from 34% to 30% in training and from 35% to 41% in test. The radiomics-based XGBoost model proposed could distinguish benign and malignant thyroid nodules, thereby reduced significantly the number of unnecessary FNAB. It was effective in making preoperative decisions and managing selected patients using the SHAP visual interpretation tools.

Comparative Study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for Diagnosis and Management of Thyroid Nodules

Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS) was developed to provide a more simplified tool for stratifying thyroid nodules. Here we aimed to validate the efficacy of C-TIRADS in distinguishing benign from malignant and in guiding fine-needle aspiration biopsies in comparison with the American College of Radiology TIRADS (ACR-TIRADS) and European TIRADS (EU-TIRADS). This study retrospectively included 3438 thyroid nodules (≥10mm) in 3013 patients (mean age, 47.1 years±12.9) diagnosed between January 2013 and November 2019. Ultrasound features of the nodules were evaluated and categorized according to the lexicons of the three TIRADS. We compared these TIRADS by using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity, specificity, net reclassification improvement (NRI), and unnecessary fine-needle aspiration biopsy (FNAB) rate. Of the 3438 thyroid nodules, 707 (20.6%) were malignant. C-TIRADS showed higher discrimination performance (AUROC, 0.857; AUPRC, 0.605) than ACR-TIRADS (AUROC, 0.844; AUPRC, 0.567) and EU-TIRADS (AUROC, 0.802; AUPRC, 0.455). The sensitivity of C-TIRADS (85.3%) was lower than that of ACR-TIRADS (89.1%) but higher than that of EU-TIRADS (78.4%). The specificity of C-TIRADS (76.9%) was similar to that of EU-TIRADS (78.9%) and higher than that of ACR-TIRADS (69.5%). The unnecessary FNAB rate was lowest with C-TIRADS (21.2%), followed by ACR-TIRADS (41.7%) and EU-TIRADS (58.3%). C-TIRADS obtained significant NRI for recommending FNAB over ACR-TIRADS (19.0%, P<0.001) and EU-TIRADS (25.5%, P<0.001). C-TIRADS may be a clinically applicable tool to manage thyroid nodules, which warrants thorough tests in other geographic settings.

Study on diagnosis of thyroid nodules based on convolutional neural network.

An artificial intelligence (AI) algorithm based on convolutional neural networks was used in ultrasound diagnosis in order to evaluate its performance in judging the nature of thyroid nodules and nodule classification. Atotal of 105patients with thyroid nodules confirmed by surgery or biopsy were retrospectively analyzed. The properties, characteristics, and classification of thyroid nodules were evaluated by sonographers and by AI to obtain combined diagnoses. Receiver operating characteristic curves were generated to evaluate the performance of AI, the sonographer, and their combined effort in diagnosing the nature of thyroid nodules and classifying their characteristics. In the diagnosis of thyroid nodules with solid components, hypoechoic appearance, indistinct borders, Anteroposterior/transverse diameter ratio> 1(A/T>1), and calcification performed by sonographers and by AI, the properties exhibited statistically significant differences. Sonographers had asensitivity of 80.7%, specificity of 73.7%, accuracy of 79.0%, and area under the curve (AUC) of 0.751 in the diagnosis of benign and malignant thyroid nodules. AI had asensitivity of 84.5%, specificity of 81.0%, accuracy of 84.7%, and AUC of 0.803. The combined AI and sonographer diagnosis had asensitivity of 92.1%, specificity of 86.3%, accuracy of 91.7%, and AUC of 0.910. The efficacy of acombined diagnosis for benign and malignant thyroid nodules is higher than that of an AI-based diagnosis alone or asonographer-based diagnosis alone. The combined diagnosis can reduce unnecessary fine-needle aspiration biopsy procedures and better evaluate the necessity of surgery in clinical practice.

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules.

Pediatric thyroid nodules have a lower prevalence but a higher rate of malignancy (ROM) than those in adults. Ultrasound features suspected of malignancy lead to fine needle aspiration biopsy (FNAB) and subsequent cytological determination, upon which management is decided. Based on the characteristics of ultrasound, to standardize clinician decisions and avoid unnecessary FNAB, the European Thyroid Association and the American Radiology College have established guidelines for Thyroid Imaging, Reporting and Data System (EU-TIRADS and ACR-TIRADS) for ROM stratification of thyroid nodules. The aim of this study is to evaluate the diagnostic performance of ACR-TIRADS and EU-TIRADS in pediatric age. Subjects younger than 18 years of age with thyroid nodules greater than 0.5 cm observed in the 2000-2020 period were included. Data from 200 subjects were collected. The overall ROM was 13%, rising to 26% if nodules with a diameter >1 cm were considered. Patients with a malignant nodule were more likely to have a higher EU-TIRADS score (p=0.03). Missed cancer diagnoses were 26.9%. Using the EU-TIRADS system, 40% of FNABs could have been avoided, while this scoring system would have resulted in FNAB being performed in 12% of cases where the assessment of ultrasound features would not recommend FNAB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.1%, 57.1%, 73.1%, and 50%, respectively. Even considering the ACR-TIRADS, a higher score correlated with a higher ROM (p<0.001). This system missed 6 diagnoses of cancer (23.1%). Using the ACR-TIRADS system, 45.3% of FNABs could have been avoided, while FNAB should have been performed in 12% of cases where it was not recommended by ultrasound characteristics. Sensitivity, specificity, PPV and NPV were 76.9%, 50%, 76.9%, and 42.9%, respectively. The present study confirms the correspondence of the EU-TIRADS and ACR-TIRADS categories with respect to malignancy but indicates not entirely satisfactory performance compared to FNAB alone. However, the use of the two TIRADS systems should be encouraged in multicentre studies to increase their performance and establish paediatric-specific points in the scoring criteria.

Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system

BACKGROUNDThis study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making. AIMTo perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules. METHODSIn accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis. RESULTSWe reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules. CONCLUSIONThese three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.

The Efficacy of ACR TI-RADS in the Management of Suspected Thyroid Nodules and Its Correlation With the Bethesda Scoring System

Objective: Ultrasonography (US) and fine-needle aspiration biopsy (FNAB) play an important role in the diagnosis of thyroid nodules. The primary aim of this study was to evaluate the relationship between American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the Bethesda system, based on final cytopathology. Materials and Methods: The cases that underwent thyroidectomy, due to a nodule, between May 2019 and May 2021 were retrospectively imaged. Of those cases, 73 patients were included in the study. The obtained data included ACR TI-RADS and the Bethesda system scores for nodules. Results: According to Spearman correlation, a very strong positive relationship was found between the Bethesda scoring system and ACR TI-RADS scores (ρ = 0.832, P &lt; .0001). A 94.4% sensitivity and 65.4% specificity were found in 16 patients with a Bethesda score of 3 and TR3 based on final pathology ( P &lt; .001). And a sensitivity of 77.3% and specificity of 51.5% were found in 17 patients, with a Bethesda score 4 and TR4 ( P &lt; .001). Finally, a sensitivity of 55.6% and specificity of 50.0% were found in 17 patients with a Bethesda score 6 and TR5 ( P &lt; .001). Conclusion: The routine use of the ACR TI-RADS classification in thyroid nodules could be useful in preventing unnecessary FNABs. It could be effective in minimizing complications secondary to FNAB and thyroidectomy and reducing costs.

A deep learning-based method for detecting and classifying the ultrasound images of suspicious thyroid nodules.

The incidence of thyroid cancer has significantly increased in the last few decades. However, diagnosis of the thyroid nodules is labor and time intensive for radiologists and strongly depends on the personal experience of the radiologists. In this pursuit, the present study envisaged to develop a deep learning-based computer-aided diagnosis (CAD) method that enabled the automatic detection and classification of suspicious thyroid nodules in order to reduce the unnecessary fine-needle aspiration biopsy. The CAD method consisted of two main parts: detecting the location of thyroid nodules using a multiscale detection network and classifying the detected thyroid nodules by an attention-based classification network. The performance of the proposed method was evaluated and compared with that of other state-of-the-art deep learning methods and experienced radiologists. The proposed detection method outperformed three other detection architectures (average precision, 82.1%vs. 78.3%, 77.2%, and 74.8%). Moreover, the classification method showed a superior performance compared with four other state-of-the-art classification networks (accuracy, 94.8%vs. 91.2%, 85.0%, 80.8%, and 72.1%) and that by experienced radiologists (mean value of area under the curve, 0.941vs. 0.833). Our study verified the high efficiency of the proposed detection method. The findings can help improve the diagnostic performance of radiologists. However, the developed CAD system requires more training and evaluation in a large-population study.

Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives.

Simple SummaryUltrasound has been used as baseline imaging for thyroid nodules for decades; nevertheless, no single feature is sensitive or specific enough to exclude or confirm thyroid malignancy. Therefore, clinical practice and research still focus on less invasive diagnostic patterns to reduce unnecessary fine-needle aspiration biopsies or surgery. The main advantage of CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, and considered a valuable new approach in the determination of benign vs. malignant nodules. In addition, contrast agents used in CEUS can help to guide treatment planning for minimally invasive procedures (e.g., ablation) and to provide accurate follow-up imaging to assess treatment efficacy in both benign and malignant nodules and associated lymph nodes. Examination protocol has almost reached standardization, although there are numerous controversies reported about the interpretation of qualitative and quantitative patterns that would require a systematic approach. This literature and current state review of CEUS in thyroid nodules address the existing concepts and highlights of the future perspectives.Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and “fast-in and slow-out” are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.

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.

Diagnostic performance of US-based FNAB criteria of the 2020 Chinese guideline for malignant thyroid nodules: comparison with the 2017 American College of Radiology guideline, the 2015 American Thyroid Association guideline, and the 2016 Korean Thyroid Association guideline.

To investigate the diagnostic performance of the ultrasonography-based fine-needle aspiration biopsy criteria of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) for malignant nodules compared to 3 other guidelines. This study included 2,309 thyroid nodules in 1,697 patients with histopathological and cytopathological diagnoses of benign and malignant nodules from January 2018 to August 2020. The clinical and ultrasonographic features of the nodules were retrospectively reviewed and classified according to the Chinese guideline (C-TIRADS), the American College of Radiology guideline (ACR-TIRADS), the American Thyroid Association guideline (ATA guideline), and the Korean Thyroid Association guideline (K-TIRADS). The diagnostic performance of the guidelines and their unnecessary fine-needle aspiration biopsy rates were calculated using randomized, blinded trials. Of the 2,309 nodules, 1,418 (61.4%) were benign and 891 (38.6%) were malignant, with 884 (99.21%) papillary carcinomas. The accuracy of C-TIRADS was 84.71%, followed by the guidelines of ACR-TIRADS (82.11%), K-TIRADS (81.64%), and the ATA guideline (78.56%). Furthermore, the area under the receiver operating characteristic curve (AUC) was the highest for the C-TIRADS (0.905). Similar results were revealed for both the diagnostic performance and AUC of nodules smaller and larger than 10 mm. The ACR-TIRADS showed the lowest unnecessary biopsy rate (17.54%), followed by the C-TIRADS (22.61%), ATA guideline (27.90%), and the K-TIRADS (28.67%). The C-TIRADS demonstrated high diagnostic performance and a relatively low unnecessary biopsy rate in detecting thyroid cancer compared to the 3 other guidelines. However, further understanding of the ultrasonography-based fine-needle aspiration biopsy criteria of the C-TIRADS should be gained in the future.

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.

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.

Comparison of the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy with three international guidelines.

PurposeThis study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines.MethodsFrom June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines.ResultsOf the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%).ConclusionThe modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

Assessment the Adherence of Radiologists to the Thyroid Imaging Reporting and Data System (TIRADS)

Introduction: Thyroid nodules are the most common findings among adults. Usually, Fine Needle Aspiration Biopsy (FNAB) can be used to distinguish the malignant and benign lesions. Application of a non-invasive method for determining the chance of malignancy in a nodule is desirable. Thyroid Imaging Reporting and Data System (TIRADS) was introduced to decrease the unnecessary FNABs and to optimize the management of these patients. The objective of this study was to assess the adherence of radiologist’s reports to TIRADS, after 10 years from the introduction of this system to radiologists in Fars Province. Methods: In this retrospective study, sonography report of the patients, who were referred to hospital for FNAB was assessed. If the patients did not have the previous sonography reports or the report was unreadable, they would be excluded from the study. Composition, echogenicity, shape, size, and margin were assessed and scored in this study. As the reports noted to each of the above-mentioned issues, score 1 was assigned to them. SPSS version 15 was used to analyze the data and calculated the standard deviation. Results: Sonography reports of 111 out of 250 patients was evaluated. The mean score of sonography reports from 5 was 2.63±0.86. The percentage of adherence of sonography reports to the expression of the first five categories was 52.61±17.25 %. Echogenic foci were also evaluated in the patients that it existed. The radiologists were reported them in almost 81% of cases. Conclusion: Overall adherence of sonographic report to TIRADS was 57.34%. The adherence can be definitely improved by training the radiologists.

False-Positive Malignant Diagnosis of Nodule Mimicking Lesions by Computer-Aided Thyroid Nodule Analysis in Clinical Ultrasonography Practice.

This study aims to test computer-aided diagnosis (CAD) for thyroid nodules in clinical ultrasonography (US) practice with a focus towards identifying thyroid entities associated with CAD system misdiagnoses. Two-hundred patients referred to thyroid US were prospectively enrolled. An experienced radiologist evaluated the thyroid nodules and saved axial images for further offline blinded analysis using a commercially available CAD system. To represent clinical practice, not only true nodules, but mimicking lesions were also included. Fine needle aspiration biopsy (FNAB) was performed according to present guidelines. US features and thyroid entities significantly associated with CAD system misdiagnosis were identified along with the diagnostic accuracy of the radiologist and the CAD system. Diagnostic specificity regarding the radiologist was significantly (p < 0.05) higher than when compared with the CAD system (88.1% vs. 40.5%) while no significant difference was found in the sensitivity (88.6% vs. 80%). Focal inhomogeneities and true nodules in thyroiditis, nodules with coarse calcification and inspissated colloid cystic nodules were significantly (p < 0.05) associated with CAD system misdiagnosis as false-positives. The commercially available CAD system is promising when used to exclude thyroid malignancies, however, it currently may not be able to reduce unnecessary FNABs, mainly due to the false-positive diagnoses of nodule mimicking lesions.

In-vivo-quantitative-ultrasound assessment of thyroid nodules

Thyroid nodules suspicious for malignancy during clinical-ultrasound (US) evaluation undergo fine-needle-aspiration biopsy (FNAB) followed by cytological evaluation and, in indeterminate cases, an additional surgical intervention or molecular testing is recommended. Quantitative ultrasound (QUS) was investigated as a non-invasive approach to detect thyroid cancer and potentially reduce the currently large number of unnecessary FNABs. RF data were acquired from 225 nodules of 208 patients using a GE Logiq E9 US equipped with a 10-MHz linear-array probe. Five QUS estimates were computed throughout each nodule. Specifically, effective scatter diameter, effective scatter concentration, midband fit, and intercept were obtained using a reference-phantom method. The Nakagami shape parameter was computed using a maximum-likelihood estimator. Mean and standard deviations (SD) of QUS estimates within nodules were used for classification. QUS-based classification performance was quantified using area-under-the-curve (AUC) values obtained from receiver-operating- characteristic analyses. An AUC value of 0.77 was obtained using the SD of intercept alone; the value increased to 0.86 when five QUS estimates were linearly combined. Our in vivo results demonstrate the potential of QUS methods to detect cancerous nodules. Ultimately, the clinical protocol could be altered to prevent FNABs of nodules highly unlikely to be malignant based on QUS analysis.

Intrathyroidal ectopic thymus tissue: a diagnostic challenge.

The prevalence of thyroid nodules in pediatric population is 0.2-2%, which is lower than adults. However, the probability of the nodule to be malignant is higher than adults (20-73%). Differential diagnosis of thyroid lesions in children includes intrathyroidal ectopic thymus tissue (ITT). ITT can present as a thyroid nodule, and be confused with malignancy with its hyperechoic pattern; this might cause unnecessary fine-needle aspiration biopsies and/or surgical interventions. In the current study, we mainly aim to define both US and color Doppler ultrasonography (CDUS) characteristics of ITT. We also aim to describe the most sensitive and most specific diagnostic parameters of ITT. We have evaluated US examination reports of 56 children for whom differential diagnosis included ITT between February 2015 and August 2018. We have recorded sonographic characteristics of the lesions, CDUS data, and thyroid hormone levels. Study population consists of 56 patients (22 ITT, 34 other diagnoses). Median age of the population is 10years. Age, sex, laboratory results, and follow-up change in lesion diameters do not show any significant difference between ITT and other diagnosis groups. Typical US appearance, fusiform lesion shape, and isovascular CDUS characteristics are higher in ITT group. The median value of the lesion's highest diameter is smaller in ITT group. The most valuable criteria to predict ITT presence were the fusiform shape and the longest diameter of the lesion. Fusiform shape and a maximum diameter of ≤ 9mm are the most selective criteria to predict ITT diagnosis.

US Fine-Needle Aspiration Biopsy for Thyroid Malignancy: Diagnostic Performance of Seven Society Guidelines Applied to 2000 Thyroid Nodules

Purpose To compare the diagnostic performance of ultrasonography (US)-based fine-needle aspiration biopsy (FNAB) criteria from seven international societies in the detection of thyroid malignancy. Materials and Methods This study included a total of 2000 consecutive thyroid nodules (≥1 cm) in 1802 patients with final diagnoses from January 2010 to May 2011. US features of the thyroid nodules were retrospectively reviewed and were classified according to the categories defined by the seven international society guidelines. The diagnostic performance of US-based FNAB criteria in the detection of thyroid malignancy and unnecessary FNAB rates were calculated and compared by using a generalized estimating equation method. Results Of the 2000 thyroid nodules, 1546 (78.3%) were benign and 454 (22.7%) were malignant, with papillary carcinoma comprising 85.5% of all malignancies. The Korean Thyroid Association/Korean Society of Thyroid Radiology (KTA/KSThR) (94.5%), National Comprehensive Cancer Network (NCCN) (92.5%), and American Thyroid Association (ATA) (89.6%) guidelines were more sensitive than those of the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.4%), American College of Radiology (ACR) (74.7%), French Society of Endocrinology (FSE) (72.7%), and Society of Radiology in Ultrasound (SRU) (70.9%) (P < .001), while the latter guidelines had higher specificity (P < .001). The rate of unnecessary FNAB was lowest with the ACR guidelines (25.3%), followed by the FSE (29.1%), AACE/ACE/AME (32.5%), SRU (45.2%), ATA (51.7%), NCCN (54.0%), and KTA/KSThR (56.9%) guidelines. Conclusion Because the diagnostic performance of US-based FNAB criteria varies according to the individual international society guidelines, clinicians should be aware of the strengths and weaknesses of US-based FNAB criteria in the management of thyroid nodules. © RSNA, 2018 Online supplemental material is available for this article.