Endocrinol Metab.  2021 Oct;36(5):1111-1120. 10.3803/EnM.2021.1208.

Comparison of Korean vs. American Thyroid Imaging Reporting and Data System in Malignancy Risk Assessment of Indeterminate Thyroid Nodules

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 3Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
  • 4Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea

Abstract

Background
The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules.
Methods
Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled.
Results
Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change.
Conclusion
K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.

Keyword

Thyroid imaging reporting and data systems; Thyroid neoplasms; Thyroid nodule; Thyroid ultrasound; Thyroid guidelines

Figure

  • Fig. 1 Receiver operating characteristic curve of Korean Thyroid Imaging Reporting and Data System (K-TIRADS), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), and fine-needle aspiration (FNA) in (A) all thyroid nodules and (B) Bethesda categories III, IV, and V.


Cited by  1 articles

Comparison of Thyroid Imaging Reporting and Data Systems in Malignancy Risk Stratification of Indeterminate Thyroid Nodules
Bo Hyun Kim
Endocrinol Metab. 2021;36(5):974-976.    doi: 10.3803/EnM.2021.1287.


Reference

1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26:1–133.
Article
2. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017; 27:1341–6.
Article
3. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: 2016 update. Endocr Pract. 2016; 22:622–39.
4. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Cytology-ultrasonography risk-stratification scoring system based on fine-needle aspiration cytology and the Korean-Thyroid Imaging Reporting and Data System. Thyroid. 2017; 27:953–9.
Article
5. Ianni F, Campanella P, Rota CA, Prete A, Castellino L, Pontecorvi A, et al. A meta-analysis-derived proposal for a clinical, ultrasonographic, and cytological scoring system to evaluate thyroid nodules: the “CUT” score. Endocrine. 2016; 52:313–21.
Article
6. Lee SW, Lee HJ, Kim HJ, Lee J, Park JY, Kim SH, et al. Combined categorical reporting systems of US and cytology findings for thyroid nodules: guidance on repeat fine-needle aspiration cytology. Radiology. 2013; 266:956–63.
Article
7. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 2017; 14:587–95.
Article
8. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 2017; 6:225–37.
Article
9. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; 17:370–95.
Article
10. Xu T, Wu Y, Wu RX, Zhang YZ, Gu JY, Ye XH, et al. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination. Endocrine. 2019; 64:299–307.
Article
11. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: toward the “right” TIRADS. J Clin Endocrinol Metab. 2019; 104:95–102.
Article
12. Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LD, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016; 2:1023–9.
Article
13. Maletta F, Massa F, Torregrossa L, Duregon E, Casadei GP, Basolo F, et al. Cytological features of “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” and their correlation with tumor histology. Hum Pathol. 2016; 54:134–42.
Article
14. Layfield LJ, Baloch ZW, Esebua M, Kannuswamy R, Schmidt RL. Impact of the reclassification of the non-invasive follicular variant of papillary carcinoma as benign on the malignancy risk of the Bethesda system for reporting thyroid cytopathology: a meta-analysis study. Acta Cytol. 2017; 61:187–93.
Article
15. Yoo WS, Ahn HY, Ahn HS, Chung YJ, Kim HS, Cho BY, et al. Malignancy rate of Bethesda category III thyroid nodules according to ultrasound risk stratification system and cytological subtype. Medicine (Baltimore). 2020; 99:e18780.
Article
16. Lim JX, Nga ME, Chan DK, Tan WB, Parameswaran R, Ngiam KY. Subclassification of Bethesda atypical and follicular neoplasm categories according to nuclear and architectural atypia improves discrimination of thyroid malignancy risk. Thyroid. 2018; 28:511–21.
Article
17. Gao LY, Wang Y, Jiang YX, Yang X, Liu RY, Xi XH, et al. Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017; 96:e6564.
18. Lee JH, Han K, Kim EK, Moon HJ, Yoon JH, Park VY, et al. Risk stratification of thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology using ultrasonography patterns defined by the 2015 ATA Guidelines. Ann Otol Rhinol Laryngol. 2017; 126:625–33.
Article
19. Ulisse S, Bosco D, Nardi F, Nesca A, D’Armiento E, Guglielmino V, et al. Thyroid imaging reporting and data system score combined with the new Italian classification for thyroid cytology improves the clinical management of indeterminate nodules. Int J Endocrinol. 2017; 2017:9692304.
Article
20. Trimboli P, Fulciniti F, Zilioli V, Ceriani L, Giovanella L. Accuracy of international ultrasound risk stratification systems in thyroid lesions cytologically classified as indeterminate. Diagn Cytopathol. 2017; 45:113–7.
Article
21. Trimboli P, Deandrea M, Mormile A, Ceriani L, Garino F, Limone PP, et al. American Thyroid Association ultrasound system for the initial assessment of thyroid nodules: use in stratifying the risk of malignancy of indeterminate lesions. Head Neck. 2018; 40:722–7.
Article
22. Maia FF, Matos PS, Pavin EJ, Zantut-Wittmann DE. Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology. Clin Endocrinol (Oxf). 2015; 82:439–44.
Article
23. Grani G, Lamartina L, Ascoli V, Bosco D, Nardi F, D’Ambrosio F, et al. Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules. Endocrine. 2017; 57:256–61.
Article
24. Słowinska-Klencka D, Wysocka-Konieczna K, Klencki M, Popowicz B. Diagnostic value of six Thyroid Imaging Reporting and Data Systems (TIRADS) in cytologically equivocal thyroid nodules. J Clin Med. 2020; 9:2281.
Article
25. Jeh SK, Jung SL, Kim BS, Lee YS. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol. 2007; 8:192–7.
Article
26. Kim DS, Kim JH, Na DG, Park SH, Kim E, Chang KH, et al. Sonographic features of follicular variant papillary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J Ultrasound Med. 2009; 28:1685–92.
Article
27. Pusztaszeri M, Auger M. Update on the cytologic features of papillary thyroid carcinoma variants. Diagn Cytopathol. 2017; 45:714–30.
Article
28. Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg. 2020; 9:1764–87.
Article
29. Saglietti C, Piana S, La Rosa S, Bongiovanni M. Hyalinizing trabecular tumour of the thyroid: fine-needle aspiration cytological diagnosis and correlation with histology. J Clin Pathol. 2017; 70:641–7.
Article
30. Evenson A, Mowschenson P, Wang H, Connolly J, Mendrinos S, Parangi S, et al. Hyalinizing trabecular adenoma: an uncommon thyroid tumor frequently misdiagnosed as papillary or medullary thyroid carcinoma. Am J Surg. 2007; 193:707–12.
31. Howard BE, Gnagi SH, Ocal IT, Hinni ML. Hyalinizing trabecular tumor masquerading as papillary thyroid carcinoma on fine-needle aspiration. ORL J Otorhinolaryngol Relat Spec. 2013; 75:309–13.
Article
32. Jang H, Park CK, Son EJ, Kim EK, Kwak JY, Moon HJ, et al. Hyalinizing trabecular tumor of the thyroid: diagnosis of a rare tumor using ultrasonography, cytology, and intraoperative frozen sections. Ultrasonography. 2016; 35:131–9.
Article
33. Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography. 2016; 35:212–9.
Article
Full Text Links
  • ENM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr