Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules
- 1.2k Downloads
To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness.
Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated.
The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3–60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4–5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9–100.0), specificity 74.35 % (95 % CI: 68.7–80.0), PPV 82.1 % (95 % CI: 78.0–86.3), NPV 99.4 % (95 % CI: 98.3–100.0), PLR 3.9 (95 % CI: 3.6–4.2) and an NLR 0.005 (95 % CI: 0.003–0.04) for malignancy.
US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk.
• TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4–5).
• The recognition of benign/possibly benign patterns can avoid unnecessary procedures.
• This classification and its sonographic patterns are validated using surgical specimens.
KeywordsThyroid nodule Thyroid neoplasm Ultrasound Risk classification Thyroid cancer
Fine needle aspiration biopsy
Positive predictive value
Negative predictive value
Positive likelihood ratio
Negative likelihood ratio
The scientific guarantor of this publication is Eleonora Horvath MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board.
Methodology: retrospective, diagnostic or prognostic study performed at one institution.
- 1.Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules (2010). Endocr Pract 16:1–43Google Scholar
- 4.American College of Radiology (ACR) (2003) ACR BI-RADS® - Ultrasound. In: ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas. Reston, VA. American College of RadiologyGoogle Scholar
- 19.Zayadeen AR, Abu-Yousef M, Berbaum K (2016) Retrospective evaluation of ultrasound features of thyroid nodules to assess malignancy risk: a step toward TIRADS. AJR 207:1–10Google Scholar
- 20.Seo H, Na DG, Kim JH, Kim KW, Yoon JW (2015) Ultrasound-based risk stratification for malignancy in thyroid nodules: a four-tier categorization system. Eur Radiol 25(7):2153–2216Google Scholar
- 21.Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, et al (2011) Guidelines of the french society of endocrinology for the management of thyroid nodules. Ann Endocrinol (Paris) 72(4):251–81Google Scholar
- 22.Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al (2005) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 237:794–800Google Scholar
- 23.American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214Google Scholar
- 24.Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al (2015) American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133Google Scholar
- 25.Cantisani V, Maceroni P, D'Andrea V, Patrizi G, Di Segni M, De Vito C, et al (2016) Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience. Eur Radiol 26(5):1441–1449Google Scholar
- 26.Giusti M, Orlandi D, Melle G, Massa B, Silvestri E, Minuto F, et al (2013) Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules? J Zhejiang Univ Sci B 14(3):195–206Google Scholar
- 27.Ma X, Zhang B, Ling W, Liu R, Jia H, Zhu F, et al (2016) Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: systematic review and meta-analysis. J Clin Ultrasound 44(4):199–209Google Scholar