ORIGINAL PAPER
Accuracy of the European Thyroid Imaging Reporting and Data System (EU-TIRADS) in the valuation of thyroid nodule malignancy in reference to the post-surgery histological results
 
More details
Hide details
 
Submission date: 2018-06-22
 
 
Acceptance date: 2018-10-29
 
 
Publication date: 2018-12-19
 
 
Pol J Radiol, 2018; 83: 577-584
 
KEYWORDS
TOPICS
ABSTRACT
Purpose:
To assess the clinical usefulness of the European Thyroid Imaging and Reporting Data System (EU-TIRADS) in the valuation of thyroid nodules malignancy in reference to post-surgery histological results.

Material and methods:
Pre-operative ultrasound was performed in consecutive patients admitted for thyroid surgery between June 2017 and January 2018. Thyroid nodules were classified according to EU-TIRADS to five groups: 1-5. At least one fine-needle aspiration biopsy (FNAB)/patient (dominant or suspected nodule) was performed in an outpatient clinic. The final diagnosis was based on the histological result. The percentage of cancers in each EU-TIRADS group was evaluated. Finally, sensitivity, specificity, accuracy, as well as positive and negative predictive values for malignancy were assessed.

Results:
Fifty-two patients with a total of 140 thyroid nodules (median: 3 nodules/thyroid [minimum-maximum: 1-6]) were enrolled in the study. Thyroid cancer was diagnosed in 0% (0/6) in EU-TIRADS 2; 0% (0/92) in EU-TIRADS 3; 5.9% (2/34) in EU-TIRADS 4, and 75% (6/8) in EU-TIRADS 5. In nodules assessed as EU-TIRADS ≥ 4 sensitivity, specificity, positive and negative predictive values for malignancy were, respectively: 75% (CI 95%: 40.7-93.5), 94.1% (CI 95%: 86.0-98.5), 75% (CI 95%: 40.7-93.5), and 94.1% (CI 95%: 86.0-98.5).

Conclusions:
EU-TIRADS is a valuable and simple tool for assessment of the risk of malignancy of thyroid nodules and demonstrates a high ultrasound correlation with histological post-surgery results. FNAB should be performed in all nodules assessed as EU-TIRADS ≥ 4, due to higher risk of malignancy.

REFERENCES (28)
1.
Gharib H, Papini E, Garber JR, 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: 622-639.
 
2.
Durante C, Grani G, Lamartina L, et al. The diagnosis and management of thyroid nodules: a review. JAMA 2018; 319: 914-924.
 
3.
Chow LS, Gharib H, Goellner JR, et al. Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 2001; 11: 1147-1151.
 
4.
Jarząb B, Dedecjus M, Słowińska-Klencka D, et al. Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma. 2018 Update. Endokrynol Pol 2018; 69: 34-74.
 
5.
Ko SY, Lee HS, Kim EK, et al. Application of the Thyroid Imaging Reporting and Data System in thyroid ultrasonography interpretation by less experienced physicians. Ultrasonography 2014; 33: 49-57.
 
6.
Lee HJ, Yoon DY, Seo YL, et al. Intraobserver and interobserver variability in ultrasound measurements of thyroid nodules. J Ultrasound Med 2018; 37: 173-178.
 
7.
Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 94: 1748-1751.
 
8.
Vanel D. The American College of Radiology (ACR) Breast Imaging and Reporting Data System (BI-RADS): a step towards a universal radiological language? Eur J Radiol 2007; 61: 183.
 
9.
Russ G, Bonnema SJ, Erdogan MF, et al. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6: 225-237.
 
10.
Trzebińska A, Dobruch-Sobczak K, Jakubowski W, et al. Standards of the Polish Ultrasound Society – update. Ultrasound examination of thyroid gland and ultrasound-guided thyroid biopsy. J Ultrason 2014; 14: 49-60.
 
11.
Park JY, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid 2009; 19: 1257-1264.
 
12.
Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892-899.
 
13.
Migda B, Migda M, Migda MS, et al. Use of the Kwak Thyroid Image Reporting and Data System (K-TIRADS) in differential diagnosis of thyroid nodules: systematic review and meta-analysis. Eur Radiol 2018; 28: 2380-2388.
 
14.
Russ G, Royer B, Bigorgne C, et al. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 2013; 168: 649-655.
 
15.
Tessler FN, Middleton WD, Grant EG, 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: 587-595.
 
16.
Horvath E, Silva CF, Majlis S, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 2017; 27: 2619-2628.
 
17.
Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99: 1253-1263.
 
18.
Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015; 25: 538-550.
 
19.
Campanella P, Ianni F, Rota CA, et al. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol 2014; 170: R203-211.
 
20.
Whittle C, García M, Horvath E, et al. Thyroid microcalcifications in the absence of identifiable nodules and their association with thyroid cancer. J Ultrasound Med 2018; 38: 97-102.
 
21.
Migda B, Migda M, Migda AM, et al. Evaluation of Four Variants of the Thyroid Imaging Reporting and Data System (TIRADS) Classification in Patients with Multinodular Goiter – initial study. Endokrynol Pol 2018; 69: 156-162.
 
22.
Dobruch-Sobczak K, Zalewska EB, Gumińska A, et al. Diagnostic performance of shear wave elastography parameters alone and in combination with conventional b-mode ultrasound parameters for the characterization of thyroid nodules: a prospective, dual-center study. Ultrasound Med Biol 2016; 42: 2803-2811.
 
23.
Gietka-Czernel M, Kochman M, Bujalska K, et al. Real-time ultrasound elastography – a new tool for diagnosing thyroid nodules. Endokrynol Pol 2010; 61: 652-657.
 
24.
Woliński K, Szczepanek-Parulska E, Stangierski A, et al. How to select nodules for fine-needle aspiration biopsy in multinodular goitre. Role of conventional ultrasonography and shear wave elastography – a preliminary study. Endokrynol Pol 2014; 65: 114-118.
 
25.
Zhao CK, Chen SG, Alizad A, et al. Three-dimensional shear wave elastography for differentiating benign from malignant thyroid nodules. J Ultrasound Med 2018; 37: 1777-1788.
 
26.
Moon HJ, Sung JM, Kim EK, et al. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 2012; 262: 1002-1013.
 
27.
Bojunga J, Herrmann E, Meyer G, et al. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010; 20: 1145-1150.
 
28.
Cantisani V, D’Andrea V, Biancari F, et al. Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur J Radiol 2012; 81: 2678-2683.
 
Journals System - logo
Scroll to top