Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules
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To assess the accuracy and reproducibility of ultrasonography classification systems in characterizing cytologically indeterminate thyroid nodules.
We retrospectively identified 49 nodules that had been surgically resected owing to features classified as indeterminate according to 2010 Italian Consensus on Thyroid Cytology criteria. Three experienced sonographers independently reviewed original sonographic images of each nodule and classified it using the 2015 American Thyroid Association (ATA) guidelines and the Thyroid Imaging Reporting and Data System (TI-RADS) classification proposed by Korean radiologists; later, images were reviewed jointly to obtain consensus classifications of each nodule. Original cytology slides were similarly reviewed by three experienced cytopathologists, who reclassified the nodule (independently, then jointly) according to revised Italian Consensus on Thyroid Cytology (ICTC-2014) criteria. Consensus ICTC-2014, ATA, and TI-RADS classifications were analyzed against surgical histology reports to estimate each system’s sensitivity, specificity, positive and negative predictive values.
Of the 49 indeterminate nodules examined, 30 (61.2 %) were histologically benign. Consensus ICTC-2014 classification correctly classified malignant nodules with positive predictive value of 50 % and negative predictive value of 90 %. Sonographic classification of nodules as intermediate to high suspicion by ATA or TI-RADS category 4c displayed positive predictive value of 63 and 71 %, respectively; positive predictive values dropped to 44 and 42 % when lower positivity thresholds were used (ATA low suspicion, TI-RADS category 4a). Negative predictive values for ATA and TI-RADS were 91 and 74 %, respectively, with higher positivity thresholds and 100 % for both with lower thresholds. All systems displayed appreciable inter-observer variability (Krippendorff alphas: ATA 0.36, TIRADS 0.42, ICTC-2014 0.74).
With stringent negativity cut-offs, American Thyroid Association and Thyroid Imaging Reporting and Data System assessment of cytologically indeterminate thyroid nodules allows high-confidence exclusion of malignancy.
KeywordsThyroid nodule Ultrasonography Indeterminate TIRADS
Medical writing was provided by M.E. Kent (EMWA) and funded by the Fondazione Umberto Di Mario. GG and LL contributed to this paper as recipients of the PhD program of Biotechnologies and Clinical Medicine of the University of Rome, Sapienza.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedüs, P. Vitti, American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pr. 16(Suppl 1),1–43 (2010)Google Scholar
- 2.British Thyroid Association and Royal College of Physicians. Guidelines for the Management of Thyroid Cancer in Adults. (RCP, London), 2002)Google Scholar
- 6.J.P. Brito, M.R. Gionfriddo, A. Al Nofal, K.R. Boehmer, A.L. Leppin, C. Reading, M. Callstrom, T.A. Elraiyah, L.J. Prokop, M.N. Stan, M.H. Murad, J.C. Morris, V.M. Montori, The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 99, 1253–1263 (2014)CrossRefPubMedGoogle Scholar
- 7.H.K. Su, L.L. Dos Reis, M.A. Lupo, M. Milas, L.A. Orloff, J.E. Langer, E.M. Brett, E. Kazam, S.L. Lee, G. Minkowitz, E.H. Alpert, E.H. Dewey, M.L. Urken, Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement. Thyroid 24, 1341–1349 (2014)CrossRefPubMedGoogle Scholar
- 9.B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016)CrossRefPubMedPubMedCentralGoogle Scholar
- 11.E.G. Grant, F.N. Tessler, J.K. Hoang, J.E. Langer, M.D. Beland, L.L. Berland, J.J. Cronan, T.S. Desser, M.C. Frates, U.M. Hamper, W.D. Middleton, C.C. Reading, L.M. Scoutt, A.T. Stavros, S.A. Teefey, Thyroid ultrasound reporting lexicon: white paper of the ACR thyroid imaging, reporting and data system (TIRADS) committee. J. Am. Coll. Radiol. JACR 12, 1272–1279 (2015)CrossRefPubMedGoogle Scholar
- 15.Y. Tutuncu, D. Berker, S. Isik, G. Akbaba, U. Ozuguz, F.K. Kucukler, E. Göcmen, Y. Yalcın, Y. Aydin, S. Guler, The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology. Endocrine 45, 37–45 (2014)CrossRefPubMedGoogle Scholar
- 19.N. Nasrollah, P. Trimboli, L. Guidobaldi, D.D. Cicciarella Modica, C. Ventura, G. Ramacciato, S. Taccogna, F. Romanelli, S. Valabrega, A. Crescenzi, Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 43, 659–665 (2013)CrossRefPubMedGoogle Scholar