Fine needle aspiration biopsy indications for thyroid nodules: compare a point-based risk stratification system with a pattern-based risk stratification system
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We aim to compare the diagnostic performance to assess thyroid nodules and reliability for recommending fine needle aspiration biopsy (FNAB) between American College of Radiology thyroid image reporting and data system (ACR TI-RADS) and American Thyroid Association (ATA) guidelines.
In total, this retrospective study included 1001 consecutive thyroid nodules in 918 patients from May 2016 to December 2017. US features of the thyroid nodules, including composition, echogenicity, shape, margins, echogenic foci, and size, were reviewed and were classified according to ACR TI-RADS and ATA guidelines, respectively. The diagnostic performance to assess thyroid nodules and reliability for recommending fine needle aspiration biopsy were compared between ACR TI-RADS and ATA guidelines.
Of the 1001 thyroid nodules, 609 (60.8%) were benign and 392 (39.2%) were malignant. The sensitivity, specificity, PPV, NPV, and accuracy were 96.7%, 77.3%, 73.3%, 97.3%, and 84.9%, respectively, for ACR TI-RADS and 99.2%, 16.1%, 43.2%, 97.0%, and 48.7%, respectively, for ATA guidelines. AUC of ACR TI-RADS was significantly greater than ATA guidelines (0.935 (0.918, 0.949) vs 0.884 (0.862, 0.903), p < 0.001). Biopsy yield of malignancy, biopsy rate of malignancy, and unnecessary FNAB rate were 59.5%, 91.3%, and 40.5%, respectively, for ACR TI-RDS and 38.5%, 97.4%, and 61.5%, respectively, for ATA guidelines.
ACR TI-RADS was more accurate than ATA guidelines for differentiating malignant thyroid nodules from benign nodules and more reliable than ATA guidelines for recommending thyroid nodules for FNAB.
• Malignant risk of thyroid nodules can be stratified by ultrasound.
• American College of Radiology guidelines were more accurate for differentiating malignant thyroid nodules from benign nodules.
• American College of Radiology guidelines were more reliable for recommending thyroid nodules for biopsy.
KeywordsFine needle aspiration biopsy Biopsy; Guidelines Thyroid nodules Ultrasound
Abbreviations and acronyms
American College of Radiology
American Thyroid Association
Area under the curve
Fine needle aspiration biopsy
Negative predictive value
Positive predictive value
Papillary thyroid cancer
Thyroid image reporting and data system
This study has received funding by Natural Science Foundation of Guangdong Province (2016A030313306) and National Natural Science Foundation of China (81671704).
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Bao-ming Luo.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products of services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic
• performed at one institution
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