Diagnostic Performance of European and American College of Radiology Thyroid Imaging Reporting and Data System Classification Systems in Thyroid Nodules Over 20 mm in Diameter.

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-22 DOI:10.1016/j.eprac.2024.10.004
Nikolaos Angelopoulos, Dimitrios G Goulis, Ioannis Chrisogonidis, Sarantis Livadas, Rodis Paparodis, Ioannis Androulakis, Ioannis Iakovou
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Abstract

Objective: The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.

Methods: From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).

Results: Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (P > .05). Two malignancies were missed.

Conclusion: EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.

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欧洲和 ACR-TIRADS 分类系统对直径超过 20 毫米的甲状腺结节的诊断性能。
背景:选择甲状腺结节进行细针穿刺(FNA)细胞学检查的挑战促使甲状腺成像报告和数据系统(TIRADS)的发展,该系统主要有两种格式:主要有两种格式:EU-TIRADS 和 ACR-TIRADS。临床观察表明,TIRADS 3 结节≥20 毫米的风险评估并不完善。本研究旨在评估 TIRADS 系统在区分该亚组良性和恶性结节方面的有效性:从 2023 年 5 月到 2024 年 3 月,1094 名甲状腺结节患者在一家大学医院接受了超声检查(US)。收集了临床、超声、细胞学和组织病理学参数数据。根据欧盟-TIRADS和ACR-TIRADS对≥20毫米的结节进行分类,并通过甲状腺切除术后组织病理学或FNA细胞学(贝塞斯达分类)评估其对恶性肿瘤的预测能力。其中记录了 22 例恶性肿瘤和 286 例良性结节。使用 25 毫米和 30 毫米阈值重新计算 EU-TIRADS 3 性能(ACR 修正版 EU-TIRADS)分别避免了 24% 和 41% 的 FNA,而 ACR-TIRADS 将避免 26.6% 的 FNA(P>0.05)。结论:结论:当使用 25 mm FNA 临界值时,EU-TIRADS 和 ACR-TIRADS 显示出相似的疗效。提高 EU-TIRADS 3 结节的 FNA 临界值可减少不必要的手术,但可能会增加漏诊恶性肿瘤的风险,影响患者的预后。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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