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Retrospective analysis of the ultrasound features of resected thyroid nodules

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Abstract

Purpose

Several ultrasound (US) risk stratification systems (US-RSSs) have been proposed to stratify the risk of malignancy (ROM) of thyroid nodules. This risk might be overestimated due to selection bias and comparison with the cytological report alone. Our study aimed to compare ROM and diagnostic performance of three guidelines (ATA, AACE/ACE/AME, EUTIRADS) and evaluate the changes in unnecessary biopsy according to the nodule size cutoff for biopsy, using histology as gold standard.

Methods

This retrospective observational study included 146 consecutive patients who underwent surgery after US and cytological characterization. We analyzed the effectiveness and accuracy of three US-RSSs.

Results

46.6% of nodules were diagnosed as malignant. Applying US-RSS, the percentage of nodules that should have been analyzed by biopsy was 84.25% with ATA, 69.86% with EUTIRADS and 64.38% with AACE/ACE/AME systems. The ROM was 94.9%, 86.0%, 87.0% for high-risk category, 36.4%, 32.0%, 35.4% for intermediate-risk category and 22.9%, 0.0%, 22.9% for low-risk category by ATA, AACE/ACE/AME and EUTIRADS systems, respectively. EUTIRADS and AACE/ACE/AME systems were more accurate in differentiating malignant from benign cases. ATA score was the more sensitive US-RSS to identify malignant tumors within the high-risk category. About the unnecessary biopsies, in the intermediate-risk category, the application of the size criterion helps to increase specificity in all systems.

Conclusions

The US categorization of low and high-risk thyroid nodules using current US-RSSs helps alone to determine the optimal treatment option. Nodule size remains relevant to recommend biopsy for the intermediate-risk category.

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Funding

This work did not receive any specific grant.

Author contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Loredana Pagano, Enrico Costantino Falco, Alessandro Gambella, Ruth Rossetto, Sara Garberoglio, Francesca Maletta, Donatella Pacchioni, Roberto Garberoglio and Mauro Giulio Papotti. Data analysis and tables designing were performed by Alessandro Bisceglia, Enrico Costantino Falco and Alessandro Gambella. The first draft of the manuscript was written by Loredana Pagano and all authors commented on previous versions of the paper. Ezio Ghigo e Mauro Giulio Papotti verified the analytical methods and supervised the manuscript drafting. All authors read and approved the final paper.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy

    Loredana Pagano, Alessandro Bisceglia, Ruth Rossetto, Sara Garberoglio, Roberto Garberoglio & Ezio Ghigo

  2. Pathology Unit, City of Health and Science University Hospital, Turin, Italy

    Enrico Costantino Falco, Alessandro Gambella, Francesca Maletta, Donatella Pacchioni & Mauro Giulio Papotti

  3. Department of Oncology, University of Turin, Turin, Italy

    Mauro Giulio Papotti

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  1. Loredana Pagano
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  2. Enrico Costantino Falco
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  5. Ruth Rossetto
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  9. Roberto Garberoglio
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Correspondence to Ezio Ghigo.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with 1964 Helsinki declaration and its later amendments; the Institutional Review Boards of our hospital approved this study.

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Patients had consented to data collection.

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Pagano, L., Falco, E.C., Bisceglia, A. et al. Retrospective analysis of the ultrasound features of resected thyroid nodules. Endocrine 72, 486–494 (2021). https://doi.org/10.1007/s12020-020-02495-y

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