, Volume 57, Issue 2, pp 256–261 | Cite as

Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules

  • Giorgio Grani
  • Livia Lamartina
  • Valeria Ascoli
  • Daniela Bosco
  • Francesco Nardi
  • Ferdinando D’Ambrosio
  • Antonello Rubini
  • Laura Giacomelli
  • Marco Biffoni
  • Sebastiano Filetti
  • Cosimo DuranteEmail author
  • Vito Cantisani
Original Article



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.


Thyroid 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.

Supplementary material

12020_2016_1148_MOESM1_ESM.pdf (392 kb)
Supplementary Information


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Giorgio Grani
    • 1
  • Livia Lamartina
    • 1
  • Valeria Ascoli
    • 2
  • Daniela Bosco
    • 2
  • Francesco Nardi
    • 2
  • Ferdinando D’Ambrosio
    • 2
  • Antonello Rubini
    • 2
  • Laura Giacomelli
    • 3
  • Marco Biffoni
    • 3
  • Sebastiano Filetti
    • 1
  • Cosimo Durante
    • 1
    Email author
  • Vito Cantisani
    • 2
  1. 1.Department of Internal Medicine and Medical Specialties“Sapienza” University of RomeRomeItaly
  2. 2.Department of Radiological, Oncological and Pathological Sciences“Sapienza” University of RomeRomeItaly
  3. 3.Department of Surgical Sciences“Sapienza” University of RomeRomeItaly

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