Risk of TIRADS-based inappropriate FNAC in autonomous thyroid nodules is clinically negligible.

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM European Thyroid Journal Pub Date : 2024-07-29 Print Date: 2024-08-01 DOI:10.1530/ETJ-24-0123
Andrea Leoncini, Chiara Camponovo, Gaetano Paone, Elena Gamarra, Giorgio Treglia, Pierpaolo Trimboli
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Abstract

Objective: Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size.

Methods: Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS.

Results: Forty-eight AFTNs were included of which 37.5% had FNAC indication according to TIRADS. The FNAC indication rate in the case of TSH lower than 0.4 mIU/L was significantly higher than in other cases (P = 0.0078). The most accurate TSH cut-off and AFTN size associated with UN-FNAC were ≤ 0.41 mIU/L and > 22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR of 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped to 4.16%.

Conclusion: Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.

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基于 TIRADS 对自主性甲状腺结节进行不适当 FNAC 的风险在临床上可以忽略不计。
目的:甲状腺结节(TN甲状腺结节(TN)通常根据甲状腺成像和报告数据系统(TIRADS)进行管理,主要目的是尽可能减少不必要的细针穿刺细胞学检查(UN-FNAC)。由于根据 TIRADS 对自主功能性甲状腺结节(AFTN)的评估存在差异,这种实际上良性的实体可能会增加 UN-FNAC 的发生率。本研究回顾性分析了基于 TIRADS 的甲状腺结节 FNAC 指征的适当性,同时还研究了 TSH 和结节大小的影响:方法:检索经闪烁扫描确诊为 AFTN 的病例。排除了接受过 AFTN 治疗、正在服用可能影响甲状腺功能的药物或补充剂或患有多个 AFTN 的患者。根据 ACR-TIRADS 对 AFTN 进行了评估:结果:共纳入 48 例 AFTN,根据 TIRADS,37.5% 的病例有 FNAC 适应症。TSH 低于 0.4 mIU/L 患者的 FNAC 适应症率明显高于其他患者(p = 0.0078)。与 UN-FNAC 相关的 TSH 和 AFTN 大小的最准确临界值分别是≤0.41 mIU/L 和 >22 mm。多变量分析表明,TSH 和结节大小都是 UN-FNAC 的独立预测因素,OR 分别为 6.65 和 6.46。根据这些数据,FNAC 适应症的比例降至 4.16%:结论:AFTN 中不适当的 FNAC 主要见于低 TSH 和大 AFTN 患者。由于这些病例通常会接受闪烁扫描,因此基于 TIRADS 的 UN-FNAC 风险在临床上可以忽略不计。没有必要将其他成像程序整合到 TIRADS 模型中。
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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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