High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?
Shadab Maqsood(1), Inzimam Wani(2), Omair Shah(3*), Tariq Gojwari(4), Zubaida Rasool(5), Bashir Laway(6), Shujaut Farooq(7)
(1) Sherikashmir Institute of Medical Sciences, India
(2) Sherikashmir Institute of Medical Sciences, India
(3) Sherikashmir Institute of Medical Sciences, India
(4) Sherikashmir Institute of Medical Sciences, India
(5) Sherikashmir Institute of Medical Sciences, India
(6) Sherikashmir Institute of Medical Sciences, India
(7) Sherikashmir Institute of Medical Sciences, India
(*) Corresponding Author
Abstract
The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC.
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1. Singer PA, Cooper DS, Daniels GH, Ladenson PW, Greenspan FS, Levy EG, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 1996;156(19):2165-72.
2.Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993; 328(8):553-9.
https://doi.org/10.1056/NEJM199302253280807
3.Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med1994; 154(16):1838-40.
https://doi.org/10.1001/archinte.154.16.1838
4.PazaitouPanayiotou K, Capezzone M, Pacini F. Clinical features and therapeutic implication of papillary thyroid micro carcinoma.Thyroid 2007;17(11):1085-92.
https://doi.org/10.1089/thy.2007.0005
5.Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid micro carcinoma should be recognized: Our treatment strategies and outcomes. World J Surg 2010;34(6):1222-31.
https://doi.org/10.1007/s00268-009-0359-x
6.Kang KW, Kim SK, Kang HS,Lee ES, Sim JS, Lee IG,et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18Ffluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab 2003; 88(9):4100-4.
https://doi.org/10.1210/jc.2003-030465
7.Cooper DS, Doherty GM, Haugen BR, KloosRT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167-214.
https://doi.org/10.1089/thy.2009.0110
8.Kung AW, Chau MT, Lao TT,Tam SCF, Law SCK.The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab 2002; 87(3):1010-4.
https://doi.org/10.1210/jcem.87.3.8285
9.Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 94(5):1748-51.
https://doi.org/10.1210/jc.2008-1724
10.Cibas ES, Ali SZ.The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017;27(11):1341-46.
https://doi.org/10.1089/thy.2017.0500
11.Paschke R,Hegedüs L, Alexander E, Valcavi R, Papini E, Gharib H. Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol2011; 7(6):354-61.
https://doi.org/10.1038/nrendo.2011.1
12.Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al.Thyroid imaging reporting and data system for ultrasound features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011;260(3):892-9.
https://doi.org/10.1148/radiol.11110206
13.Moifo B, TakoetaEO, Tambe J, Blanc F. Reliability of thyroid imaging reporting and data system (TIRADS) classification in differentiating benign from malignant thyroid nodules. Open J Radiol 2013; 3(3):103.
https://doi.org/10.4236/ojrad.2013.33016.
14.ChandramohanA, Khurana A, Pushpa BT, ManipadamMT, Naik D, Thomas N, et al. Is TIRADS a practical and accurate system for use in daily clinical practice? Indian J Radiol Imaging 2016; 26(1):145-52.
https://doi.org/10.4103/0971-3026.178367
15.Srinivas MN, Amogh VN, Gautam MS, Prathyusha IS, Vikram NR, Retnam MK, Balakrishna BV, Kudva N. A Prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions. J Clin Imaging Sci 2016 26;6:5.
https://doi.org/10.4103/2156-7514.177551
DOI: https://doi.org/10.19106/JMedSci005502202302
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