An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management.
ABSTRACT There is a high prevalence of thyroid nodules on ultrasonographic (US) examination. However, most of them are benign. US criteria may help to decide cost-effective management.
Our objective was to develop a standardized US characterization and reporting data system of thyroid lesions for clinical management: the Thyroid Imaging Reporting and Data System (TIRADS).
This was a prospective study using the TIRADS, which is based on the concepts of the Breast Imaging Reporting Data System of the American College of Radiology.
A correlation of the US findings and fine needle aspiration biopsy (FNAB) results in 1959 lesions biopsied under US guidance and studied histologically during an 8-yr period was divided into three stages. In the first stage, 10 US patterns were defined. In the second stage, four TIRADS groups were defined according to risk. The percentages of malignancy defined in the Breast Imaging Reporting and Data System were followed: TIRADS 2 (0% malignancy), TIRADS 3 (<5% malignancy), TIRADS 4 (5-80% malignancy), and TIRADS 5 (>80% malignancy).
The TIRADS classification was evaluated at the third stage of the study in a sample of 1097 nodules (benign: 703; follicular lesions: 238; and carcinoma: 156). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88, 49, 49, 88, and 94%, respectively. The ratio of benign to malignant or follicular FNAB results currently is 1.8.
The TIRADS has allowed us to improve patient management and cost-effectiveness, avoiding unnecessary FNAB. In addition, we have established standard codes to be used both for radiologists and endocrinologists.
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ABSTRACT: To verify the usefulness of the Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodule diagnosis by less experienced physicians.Ultrasonography (Seoul, Korea). 01/2014; 33(1):49-57.
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ABSTRACT: Objective. Ultrasonographic characteristics are associated with thyroid malignancy. Our aim was to compare the diagnostic value of ultrasound features in the detection of thyroid malignancy in both solid and mixed nodules. Methods. We prospectively studied female patients (≥50 years) referred to ultrasound-guided fine needle aspiration biopsy. Ultrasound features considered suspicious were hypoechogenicity, microcalcifications, irregular margins, high anteroposterior (AP)/axial-ratio, and absent halo. Associations were separately assessed in mixed and solid nodules. Results. In a group of 504 elderly female patients (age = 69 ± 8 years), the frequency of malignant cytology was 6%. Thirty-one percent of nodules were mixed and 60% were solid. The rate of malignant cytology was similar for mixed and solid nodules (7.4 versus 5.8%, P: 0.56). While in mixed nodules none of the ultrasound characteristics were associated with malignant cytology, in solid nodules irregular margins and microcalcifications were significant (all P < 0.05). The combination of irregular margins and/or microcalcifications significantly increased the association with malignant cytology only in solid nodules (OR: 2.76 (95% CI: 1.25-6.10), P: 0.012). Conclusions. Ultrasound features were of poor diagnostic value in mixed nodules, which harbored malignant lesions as often as solid nodules. Our findings challenge the recommended minimal size for ultrasound-guided fine needle aspiration biopsy in mixed nodules.Journal of thyroid research. 01/2014; 2014:761653.
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ABSTRACT: Objective The classification system of the thyroid nodules (TN) TI-RADS (Thyroid Imaging Reporting and Data System) proposed by Horvath et al. in 2009 is rarely used. The aim of this study was to evaluate a modification of the score regarding the ultrasound criteria for malignancy in order to obtain a better application of this classification in daily practice. Materials and methods 3650 TN were classified according a score of possible malignancy. According published studies and guidelines of several medical international societies, suspicious US criteria for malignancy are defined. Each of them gets one point for the final score of malignant probability of the TN. If suspected cervical lymph nodes are detected, one point is added. Results The score in all benign (TI-RADS 2) or probably benign (TI-RADS 3) TN was zero. In the TI-RADS 3 group only 2,2% of the TN were malignant. The score of TI-RADS 4a, 4b and 4c was one, two and three to four points, respectively. Here the malignant rate was 9,5%, 48% and 85%, respectively. TI-RADS 5 TN had a score of five or more points with a malignancy of 100% in this study. Conclusion A TI-RADS classification based on a score according the number of suspicious US criteria defined for malignancy can be applied in daily practice.Revista Argentina de Radiología. 07/2014;