Using the Ata and Acr Ti-Rads Sonographic Classifications as Adjunctive Predictors of Malignancy for Indeterminate Thyroid Nodules |
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| Institution: | 1. From the Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, North Carolina;2. Department of Biostatistics, Duke Cancer Institute, Durham, North Carolina;3. Department of Pathology, Duke University Medical Center, Durham, North Carolina;4. Department of Surgery, University of California at San Francisco-UCSF, San Francisco, California.;1. Department of Pathology, University of Yamanashi, Chuo, Japan;2. Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam;3. Department of Pathology, Kameda Medical Center, Kamogawa City, Chiba, Japan;4. Department of Hospital Pathology, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea;5. Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma city, Nara, Japan.;1. From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;2. Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center/Bellevue Hospital Center, New York, New York;3. Department of Public Health Sciences, Loyola University, Maywood, Illinois.;1. Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;2. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD;3. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD;4. Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA;5. Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;1. From Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of medicine, Southeast University, Nanjing, China;2. Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, School of medicine, Southeast University, Nanjing, China.;1. Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 |
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| Abstract: | Objective: Thyroid nodules with indeterminate cytology pose management challenges in clinical practice. The aim of this study was to determine the efficacy of ultrasound features in navigating clinical decision making in thyroid nodules with indeterminate cytology.Methods: We retrospectively reviewed ultrasound imaging from 186 adult patients with thyroid nodules and indeterminate cytology who underwent thyroidectomy at a quaternary hospital from 2010–2017. All nodules were classified based on the American Thyroid Association (ATA) and 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Nodules were included if good quality pre-operative ultrasound imaging and surgical pathology were available.Results: A total of 202 thyroid nodules were included. The median age was 57 years; 82.8% were female. Risk of malignancy (ROM) in resected nodules with Bethesda 3 and 4 cytology was 19.4% and 30.3%, respectively. ATA high-suspicious and TI-RADS 5 nodules had high ROM, 100% in both systems for Bethesda 3 nodules; 66.7% and 50.0%, respectively, for Bethesda 4 nodules. For ATA very-low suspicious/TI-RADS 1 and 2, ROM was 0%. ROM in ATA low-suspicious/TI-RADS 3 nodules with Bethesda 3 cytology was lower (15.2% and 16.0%, respectively) than Bethesda 4 cytology (33.8% and 34.3%, respectively). ATA intermediate-suspicious/TI-RADS 4 nodules with Bethesda 4 cytology had a lower ROM (11.1% and 18.2%, respectively) than Bethesda 3 cytology (28.6 % and 31.6%, respectively).Conclusion: Using either the ATA or the TI-RADS system to risk-stratify nodules with indeterminate cytology may help clinicians plan better for additional diagnostic testing and treatment.Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; AUS = atypia of undetermined significance; FLUS = follicular lesion of undetermined significance; FN = follicular neoplasm; PPV = positive predictive value; ROM = risk of malignancy; SFN = suspicious for follicular neoplasm; TI-RADS = Thyroid Imaging Reporting and Data System |
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