Combining TSH measurement with TIRADS assessment to further improve the detection of thyroid cancers.

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2024-06-01 DOI:10.23736/S2724-6507.24.04207-6
Pierpaolo Trimboli, Marco Curti, Amos Colombo, Lorenzo Scappaticcio, Andrea Leoncini
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Abstract

Background: Thyroid Imaging Reporting and Data Systems (TIRADSs) have demonstrated high performance in risk stratification of thyroid nodules (TNs). However, further improvements are needed in view of the ongoing project of an international TIRADS. Even if thyroid-stimulating hormone (TSH) measurement is traditionally used to assess the thyroid function, several papers have reported that higher TSH levels are associated with the presence of differentiated thyroid carcinoma (DTC). The present study aimed to investigate the role of TSH levels as improvement factor of American College of Radiology (ACR-), European Thyroid Association (EU-), and Korean Society (K-)TIRADS.

Methods: Patients undergoing thyroidectomy were reviewed and TNs were re-assessed according to TIRADSs. Different TSH subgroups were attained. Histology was the reference standard. DTC risk of relapse was assessed according to American Thyroid Association guidelines.

Results: The study series included 97 patients with 39.2% cancer prevalence. ACR-, EU-, and K-TIRADS indicated fine-needle aspiration cytology (FNAC) in 78.9%, 81.6%, and 92.1% of cases, respectively. All high-risk DTC had FNAC indication according to the three TIRADSs. The cancer rate was significantly lower in patients with TSH<0.4 mIU/L (P=0.04). The receiver operating characteristic (ROC) curve analysis showed that the best TSH cut-off to detect DTC patient was >1.3 mIU/L with Area Under the Curve (AUC)=0.70. Combining TSH data with TIRADS, the sensitivity of ACR-, EU-, and K-TIRADS increased to 92.1% 89.5%, and 94.7%, respectively. Conversely, the rate of unnecessary FNAC raised. At multivariate analysis, gender, TSH, and TIRADS were independent predictors of cancer.

Conclusions: Even if TIRADSs are strongly reliable to stratify the risk of malignancy of TNs, measuring TSH can further improve our sensitivity in detecting DTC.

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将 TSH 测量与 TIRADS 评估相结合,进一步提高甲状腺癌的检测水平。
背景:甲状腺成像报告和数据系统(TIRADS甲状腺成像报告和数据系统(TIRADS)在甲状腺结节(TNs)的风险分层方面表现出色。然而,鉴于国际 TIRADS 项目正在进行中,还需要进一步改进。尽管促甲状腺激素(TSH)测量是评估甲状腺功能的传统方法,但有多篇论文报道,TSH水平越高,分化型甲状腺癌(DTC)的发病率越高。本研究旨在探讨 TSH 水平作为美国放射学会(ACR-)、欧洲甲状腺协会(EU-)和韩国学会(K-)TIRADS 改善因素的作用:对接受甲状腺切除术的患者进行复查,并根据 TIRADS 重新评估 TNs。得出不同的 TSH 亚组。组织学是参考标准。根据美国甲状腺协会指南评估DTC复发风险:该研究系列包括97名患者,癌症发病率为39.2%。ACR-、EU-和K-TIRADS分别有78.9%、81.6%和92.1%的病例需要进行细针穿刺细胞学检查(FNAC)。根据三种 TIRADS,所有高风险 DTC 都有 FNAC 指征。TSH 为 1.3 mIU/L 的患者癌症发生率明显较低,曲线下面积 (AUC) = 0.70。将 TSH 数据与 TIRADS 结合后,ACR-、EU- 和 K-TIRADS 的灵敏度分别提高到 92.1% 89.5% 和 94.7%。相反,不必要的 FNAC 发生率却有所上升。在多变量分析中,性别、TSH 和 TIRADS 是癌症的独立预测因素:尽管TIRADS在TN恶性风险分层方面非常可靠,但测量TSH可进一步提高我们检测DTC的灵敏度。
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