Using an ultrasonography risk stratification system to enhance the thyroid fine needle aspiration performance

• Published in: European journal of radiology Vol. 150; p. 110244
• Main Authors: Strieder, Débora L., Cristo, Ana P., Zanella, André B., Faccin, Carlo S., Farenzena, Mauricio, Graudenz, Márcia S., Dora, José Miguel, Maia, Ana Luiza, Scheffel, Rafael Selbach
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2022
• Subjects: Biopsy, Fine-Needle - methods; Diagnostic; Fine needle biopsy; Humans; Retrospective Studies; Risk Assessment; Thyroid cancer; Thyroid imaging reporting and data system; Thyroid nodule; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - pathology; Ultrasonography; Ultrasonography - methods; Thyroid nodule; Fine needle biopsy; Diagnostic; Thyroid cancer; Thyroid imaging reporting and data system; Ultrasonography
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2022.110244

•ACR TI-RADS uses a point summation to stratify malignancy of thyroid nodules.•We observed negative predictive value of 97.6% and accuracy of 73.1% for TI-RADS.•ACR TI-RADS reduces the number of fine needle aspiration biopsy indications.•The false negative rate was 2.3%, but only 7 malignant cases would be missed.•TI-RADS significant decrease the number of FNAB and increase diagnostic accuracy. Purpouse. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a risk stratification system for thyroid nodules based on their ultrasonography (US) characteristics. Here, we aimed to assess TI-RADS on fine needle aspiration biopsy (FNAB) recommendations and performance in thyroid nodules. We performed a retrospective study in a single center. All patients with thyroid nodules who underwent FNAB between 2012 and 2019 were included. TI-RADS data were extracted from medical records. Malignancy rates were defined based on cytological exams. A total of 1,044 nodules (938 patients) were evaluated. TI-RADS classification was as follows: 13 TI-RADS 1, 524 TI-RADS 2, 273 TI-RADS 3, 148 TI-RADS 4, and 85 TI-RADS 5. TI-RADS classification showed a sensitivity of 75% (95 %CI: 63–84.7), a negative predictive value of 97.6% (95 %CI: 96.5–98.5), and accuracy of 73.1% (95 %CI: 70.3–75.8). According to TI-RADS FNAB criteria, only 314 (30%) nodules would have undergone FNAB. Of them, 157 (50%) were classified as benign (Bethesda II), 45 (14.3%) as undetermined (Bethesda III or IV), and 51 (16.2%) as malignant (Bethesda V or VI). Of the remaining 729 nodules that did not meet FNAB criteria, 17 (2.3%) had Bethesda V or VI and underwent surgery. Of them, four (23%) were <1 cm in size (microcarcinomas), and eight (47.0%) remain in follow-up according to the TI-RADS criteria. Seven malignant cases would be missed (0.9%). ACR TI-RADS allows a significant decrease in the number of FNAB, increasing its diagnostic accuracy.