ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology
Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in a...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Endocrine Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12902-019-0429-5 |
| _version_ | 1818205728127582208 |
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| author | Thayse Lozovoy Madsen Barbosa Cleo Otaviano Mesa Junior Hans Graf Teresa Cavalvanti Marcus Adriano Trippia Ricardo Torres da Silveira Ugino Gabriel Lucca de Oliveira Victor Hugo Granella Gisah Amaral de Carvalho |
| author_facet | Thayse Lozovoy Madsen Barbosa Cleo Otaviano Mesa Junior Hans Graf Teresa Cavalvanti Marcus Adriano Trippia Ricardo Torres da Silveira Ugino Gabriel Lucca de Oliveira Victor Hugo Granella Gisah Amaral de Carvalho |
| author_sort | Thayse Lozovoy Madsen Barbosa |
| collection | DOAJ |
| description | Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V. |
| first_indexed | 2024-12-12T04:01:44Z |
| format | Article |
| id | doaj.art-12328dd043af450caa6cd128e4238e1a |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-12-12T04:01:44Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Endocrine Disorders |
| spelling | doaj.art-12328dd043af450caa6cd128e4238e1a2022-12-22T00:39:01ZengBMCBMC Endocrine Disorders1472-68232019-10-0119111110.1186/s12902-019-0429-5ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytologyThayse Lozovoy Madsen Barbosa0Cleo Otaviano Mesa Junior1Hans Graf2Teresa Cavalvanti3Marcus Adriano Trippia4Ricardo Torres da Silveira Ugino5Gabriel Lucca de Oliveira6Victor Hugo Granella7Gisah Amaral de Carvalho8Department of Endocrinology and Metabology, Federal University of Paraná– BrazilDepartment of Endocrinology and Metabology, Federal University of Paraná– BrazilDepartment of Endocrinology and Metabology, Federal University of Paraná– BrazilDepartment of Pathology, Clinical Hospital of the Federal University of ParanáRadiologyMedical School, Federal University of ParanáMedical School, Federal University of ParanáMedical School, Federal University of ParanáDepartment of Endocrinology and Metabology, Federal University of Paraná– BrazilAbstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.http://link.springer.com/article/10.1186/s12902-019-0429-5Thyroid nodulesIndeterminateACR TI-RADSAmerican Thyroid Association (ATA) guidelinesUltrasonography |
| spellingShingle | Thayse Lozovoy Madsen Barbosa Cleo Otaviano Mesa Junior Hans Graf Teresa Cavalvanti Marcus Adriano Trippia Ricardo Torres da Silveira Ugino Gabriel Lucca de Oliveira Victor Hugo Granella Gisah Amaral de Carvalho ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology BMC Endocrine Disorders Thyroid nodules Indeterminate ACR TI-RADS American Thyroid Association (ATA) guidelines Ultrasonography |
| title | ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology |
| title_full | ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology |
| title_fullStr | ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology |
| title_full_unstemmed | ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology |
| title_short | ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology |
| title_sort | acr ti rads and ata us scores are helpful for the management of thyroid nodules with indeterminate cytology |
| topic | Thyroid nodules Indeterminate ACR TI-RADS American Thyroid Association (ATA) guidelines Ultrasonography |
| url | http://link.springer.com/article/10.1186/s12902-019-0429-5 |
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