Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study
We compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsa...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-04-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/13/8/1948 |
| _version_ | 1797537257394012160 |
|---|---|
| author | You-Bin Lee Young-Lyun Oh Jung-Hee Shin Sun-Wook Kim Jae-Hoon Chung Yong-Ki Min Soo-Yeon Hahn Tae-Hyuk Kim |
| author_facet | You-Bin Lee Young-Lyun Oh Jung-Hee Shin Sun-Wook Kim Jae-Hoon Chung Yong-Ki Min Soo-Yeon Hahn Tae-Hyuk Kim |
| author_sort | You-Bin Lee |
| collection | DOAJ |
| description | We compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsatisfactory aspirations from April 2011 to March 2016, malignancy was detected in 39 of 89 excised nodules. The minimum malignancy rate was 7.82% in EU-TIRADS 5 and 1.87–3.00% in EU-TIRADS 3–4. In the other systems, the minimum malignancy rate was 14.29–16.19% in category 5 and ≤3% in the remaining categories. Although the EU-TIRADS category ≥ 5 exhibited the highest positive likelihood ratio (LR) of only 2.214, category ≥ 5 in the other systems yielded the highest positive LR of >5. Receiver operating characteristic (ROC) curves of all systems to predict malignancy were located statistically above the diagonal nondiscrimination line (P for ROC curve: EU-TIRADS, 0.0022; all others, 0.0001). The areas under the ROC curve (AUCs) were not significantly different among the four systems. The ATA guidelines, K-TIRADS, and ACR TIRADS may be useful to guide management for nondiagnostic/unsatisfactory nodules. The EU-TIRADS, although also useful, exhibited inferior performance in predicting malignancy for nondiagnostic/unsatisfactory nodules in Korea, an iodine-sufficient area. |
| first_indexed | 2024-03-10T12:12:35Z |
| format | Article |
| id | doaj.art-72e48f4d500f465a9e868f574258a637 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T12:12:35Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-72e48f4d500f465a9e868f574258a6372023-11-21T16:05:24ZengMDPI AGCancers2072-66942021-04-01138194810.3390/cancers13081948Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World StudyYou-Bin Lee0Young-Lyun Oh1Jung-Hee Shin2Sun-Wook Kim3Jae-Hoon Chung4Yong-Ki Min5Soo-Yeon Hahn6Tae-Hyuk Kim7Samsung Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Pathology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaSamsung Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaWe compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsatisfactory aspirations from April 2011 to March 2016, malignancy was detected in 39 of 89 excised nodules. The minimum malignancy rate was 7.82% in EU-TIRADS 5 and 1.87–3.00% in EU-TIRADS 3–4. In the other systems, the minimum malignancy rate was 14.29–16.19% in category 5 and ≤3% in the remaining categories. Although the EU-TIRADS category ≥ 5 exhibited the highest positive likelihood ratio (LR) of only 2.214, category ≥ 5 in the other systems yielded the highest positive LR of >5. Receiver operating characteristic (ROC) curves of all systems to predict malignancy were located statistically above the diagonal nondiscrimination line (P for ROC curve: EU-TIRADS, 0.0022; all others, 0.0001). The areas under the ROC curve (AUCs) were not significantly different among the four systems. The ATA guidelines, K-TIRADS, and ACR TIRADS may be useful to guide management for nondiagnostic/unsatisfactory nodules. The EU-TIRADS, although also useful, exhibited inferior performance in predicting malignancy for nondiagnostic/unsatisfactory nodules in Korea, an iodine-sufficient area.https://www.mdpi.com/2072-6694/13/8/1948thyroidfine-needle aspirationnondiagnosticunsatisfactorythyroid imagingreporting and data system (TIRADS) |
| spellingShingle | You-Bin Lee Young-Lyun Oh Jung-Hee Shin Sun-Wook Kim Jae-Hoon Chung Yong-Ki Min Soo-Yeon Hahn Tae-Hyuk Kim Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study Cancers thyroid fine-needle aspiration nondiagnostic unsatisfactory thyroid imaging reporting and data system (TIRADS) |
| title | Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study |
| title_full | Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study |
| title_fullStr | Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study |
| title_full_unstemmed | Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study |
| title_short | Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study |
| title_sort | comparison of four ultrasonography based risk stratification systems in thyroid nodules with nondiagnostic unsatisfactory cytology a real world study |
| topic | thyroid fine-needle aspiration nondiagnostic unsatisfactory thyroid imaging reporting and data system (TIRADS) |
| url | https://www.mdpi.com/2072-6694/13/8/1948 |
| work_keys_str_mv | AT youbinlee comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT younglyunoh comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT jungheeshin comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT sunwookkim comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT jaehoonchung comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT yongkimin comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT sooyeonhahn comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy AT taehyukkim comparisonoffourultrasonographybasedriskstratificationsystemsinthyroidnoduleswithnondiagnosticunsatisfactorycytologyarealworldstudy |