Diagnostic performance of European and ACR-TIRADS classification systems in thyroid nodules over 20 mm in diameter.
Fine Needle Aspiration
Thyroid Imaging Reporting and Data Systems
thyroid malignancy
Journal
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
ISSN: 1530-891X
Titre abrégé: Endocr Pract
Pays: United States
ID NLM: 9607439
Informations de publication
Date de publication:
21 Oct 2024
21 Oct 2024
Historique:
received:
20
08
2024
revised:
23
09
2024
accepted:
11
10
2024
medline:
24
10
2024
pubmed:
24
10
2024
entrez:
23
10
2024
Statut:
aheadofprint
Résumé
The challenge of selecting thyroid nodules for fine-needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System (TIRADS), primarily in two formats: EU-TIRADS and ACR-TIRADS. Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup. From May 2023 to March 2024, 1,094 patients with thyroid nodules were referred for ultrasound (US) at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through post-thyroidectomy histopathology or FNA cytology (Bethesda classification). 267 patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating EU-TIRADS 3 performance using 25 mm and 30 mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (p>0.05). Two malignancies were missed. EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cut-off for FNA in EU-TIRADS 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
The challenge of selecting thyroid nodules for fine-needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System (TIRADS), primarily in two formats: EU-TIRADS and ACR-TIRADS. Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.
MATERIALS AND METHODS
METHODS
From May 2023 to March 2024, 1,094 patients with thyroid nodules were referred for ultrasound (US) at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through post-thyroidectomy histopathology or FNA cytology (Bethesda classification).
RESULTS
RESULTS
267 patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating EU-TIRADS 3 performance using 25 mm and 30 mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (p>0.05). Two malignancies were missed.
CONCLUSION
CONCLUSIONS
EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cut-off for FNA in EU-TIRADS 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.
Identifiants
pubmed: 39442878
pii: S1530-891X(24)00796-1
doi: 10.1016/j.eprac.2024.10.004
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.