Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison
<i>Background and Objectives</i>: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non-marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adj...
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MDPI AG
2022-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/2/257 |
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| author | Peteris Prieditis Maija Radzina Madara Mikijanska Mara Liepa Kaspars Stepanovs Giorgio Grani Cosimo Durante Livia Lamartina Pierpaolo Trimboli Vito Cantisani |
| author_facet | Peteris Prieditis Maija Radzina Madara Mikijanska Mara Liepa Kaspars Stepanovs Giorgio Grani Cosimo Durante Livia Lamartina Pierpaolo Trimboli Vito Cantisani |
| author_sort | Peteris Prieditis |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non-marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M-TIRADS score. <i>Materials and Methods</i>: A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound-guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M-TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller-than-wide shape, metastatic lymph nodes). Non-marked hypoechoic nodules were classified as TIRADS 3. <i>Results</i>: Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub-cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M-TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR—18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M-TIRADS and Kwak systems—0.9 vs. 0.8, respectively). Accuracy of M-TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. <i>Conclusions</i>: The non-marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M-TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA. |
| first_indexed | 2024-03-09T21:29:55Z |
| format | Article |
| id | doaj.art-cae47feb36194156901bebd1f39bc22b |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T21:29:55Z |
| publishDate | 2022-02-01 |
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| series | Medicina |
| spelling | doaj.art-cae47feb36194156901bebd1f39bc22b2023-11-23T21:00:30ZengMDPI AGMedicina1010-660X1648-91442022-02-0158225710.3390/medicina58020257Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems ComparisonPeteris Prieditis0Maija Radzina1Madara Mikijanska2Mara Liepa3Kaspars Stepanovs4Giorgio Grani5Cosimo Durante6Livia Lamartina7Pierpaolo Trimboli8Vito Cantisani9Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, LatviaRadiology Research Laboratory, Riga Stradins University, LV-1007 Riga, LatviaDiagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, LatviaRadiology Research Laboratory, Riga Stradins University, LV-1007 Riga, LatviaDiagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, LatviaDepartment of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, ItalyDepartment of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, ItalyDepartment of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, ItalyClinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandDepartment of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy<i>Background and Objectives</i>: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non-marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M-TIRADS score. <i>Materials and Methods</i>: A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound-guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M-TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller-than-wide shape, metastatic lymph nodes). Non-marked hypoechoic nodules were classified as TIRADS 3. <i>Results</i>: Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub-cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M-TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR—18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M-TIRADS and Kwak systems—0.9 vs. 0.8, respectively). Accuracy of M-TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. <i>Conclusions</i>: The non-marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M-TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.https://www.mdpi.com/1648-9144/58/2/257thyroid noduleTIRADSaspiration biopsyultrasoundthyroid cancer |
| spellingShingle | Peteris Prieditis Maija Radzina Madara Mikijanska Mara Liepa Kaspars Stepanovs Giorgio Grani Cosimo Durante Livia Lamartina Pierpaolo Trimboli Vito Cantisani Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison Medicina thyroid nodule TIRADS aspiration biopsy ultrasound thyroid cancer |
| title | Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison |
| title_full | Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison |
| title_fullStr | Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison |
| title_full_unstemmed | Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison |
| title_short | Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison |
| title_sort | non marked hypoechogenic nodules multicenter study on the thyroid malignancy risk stratification and accuracy based on tirads systems comparison |
| topic | thyroid nodule TIRADS aspiration biopsy ultrasound thyroid cancer |
| url | https://www.mdpi.com/1648-9144/58/2/257 |
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