Skip to main content
SpringerLink
Log in

FNA indication according to ACR-TIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18F-FDG PET/CT

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Objective

Focal thyroid incidentaloma (TI) occurs in a 2% of 18F-FDG PET/CT and about one-third of TIs is cancer. Due to the lack of evidence on the optimal management of TI, current guidelines suggest performing fine-needle aspiration cytology (FNA). The study aim was to evaluate the reliability of ACR-TIRADS, EU-TIRADS, and K-TIRADS in indicating FNA in TIs.

Design

We retrospectively reviewed 18F-FDG PET/CT TIs recorded during the period 2016–2019. Enrolled were TIs with histologic outcome and autonomous nodules. Cases with uncertain matching between 18F-FDG PET/CT, US/scintiscan and histology were excluded.

Results

Eighty TIs at 18F-FDG PET/CT (median size 17 mm, median SUVmax 7.85) were included; a 26.2% was cancer. The percentage of nodules classified as high risk according to ACR-TIRADS, EU-TIRADS, and K-TIRADS was 20%, 30%, and 29.8%, respectively. The cancer prevalence in high-risk class was 56.2%, 66.7%, and 65.2% in ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively. ACR-TIRADS had the lowest number of cases with FNA indication (48%) and the K-TIRADS, the highest one (75%). Evaluating the reliability of the three systems in indicating FNA, we found a 100% sensitivity and NPV for EU-TIRADS and K-TIRADS; while all the three systems showed poor specificity and PPV.

Conclusion

All TIRADSs were reliable to stratify the risk of cancer in focal TI. Comparing their reliability in indicating FNA, we found a good performance of EU-TIRADS and K-TIRADS. Considering the high cancer percentage expected in this setting of patients, those TIRADS with higher propensity to indicate FNA should be preferred.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jin J, McHenry CR (2012) Thyroid incidentaloma. Best Pract Res Clin Endocrinol Metab 26:83–96

    Article  Google Scholar 

  2. Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L (2013) Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 52:130–136

    Article  CAS  Google Scholar 

  3. Bertagna F, Treglia G, Piccardo A, Giubbini R (2012) Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab 97:3866–3875

    Article  CAS  Google Scholar 

  4. Signore G, Albano D, Giovanella L, Bertagna F, Treglia G (2019) Evidence-based data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Curr Radiopharm. https://doi.org/10.2174/1874471012666191212115732

    Article  Google Scholar 

  5. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 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

    Article  Google Scholar 

  6. Castellana M, Castellana C, Treglia G, Giorgino F, Giovanella L, Russ G, Trimboli P (2019) Performance of five ultrasound risk stratification systems in selecting thyroid nodules for FNA. A meta-analysis. J Clin Endocrinol Metab. https://doi.org/10.1210/clinem/dgz170

    Article  Google Scholar 

  7. Trimboli P, Durante C (2020) Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era. Endocrine. https://doi.org/10.1007/s12020-020-02196-6

    Article  PubMed  PubMed Central  Google Scholar 

  8. Trimboli P, Paone G, Treglia G, Virili C, Ruberto T, Ceriani L, Piccardo A, Giovanella L (2018) Fine-needle aspiration in all thyroid incidentalomas at 18 F-FDG PET/CT: can EU-TIRADS revise the dogma? Clin Endocrinol (Oxf) 89(5):642–648. https://doi.org/10.1111/cen.13819

    Article  CAS  Google Scholar 

  9. Chung SR, Choi YJ, Suh CH, Kim HJ, Lee JJ, Kim WG, Sung TY, Lee YM, Song DE, Lee JH, Baek JH (2018) Thyroid incidentalomas detected on 18f-fluorodeoxyglucose positron emission tomography with computed tomography: malignant risk stratification and management plan. Thyroid 28(6):762–768. https://doi.org/10.1089/thy.2017.0560

    Article  CAS  PubMed  Google Scholar 

  10. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT (2017) ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 14(5):587–595

    Article  Google Scholar 

  11. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L (2017) European Thyroid Association Guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J 6:225–237

    Article  Google Scholar 

  12. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, Lim HK, Moon WJ, Na DG, Park JS, Choi YJ, Hahn SY, Jeon SJ, Jung SL, Kim DW, Kim EK, Kwak JY, Lee CY, Lee HJ, Lee JH, Lee JH, Lee KH, Park SW, Sung JY, Korean Society of Thyroid Radiology (KSThR), and Korean Society of Radiology (2016) Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of thyroid radiology consensus statement and recommendations. Korean J Radiol. 17(3):370–395

    Article  Google Scholar 

  13. Giovanella L, D'Aurizio F, Campenni' A, Ruggeri RM, Baldari S, Verburg FA, Trimboli P, Ceriani L (2016) Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions. Endocrine 54:757–761

    Article  CAS  Google Scholar 

  14. Giovanella L, Ceriani L, Treglia G (2014) Role of isotope scan, including positron emission tomography/computed tomography, in nodular goitre. Best Pract Res Clin Endocrinol Metab 28:507–518

    Article  Google Scholar 

  15. Boellaard R, Tatsch K, Pike LC, Testanera G, Kotzerke J, Graham MM et al (2014) FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 42(2):328–354

    Article  Google Scholar 

  16. Galen RS, Gambino SL (1975) How to determine the predictive value and efficiency of a test when reading a scientific paper. Beyond normality: the predictive value and efficiency of medical diagnosis. Wiley, New York

    Google Scholar 

  17. Pattison DA, Bozin M, Gorelik A, Hofman MS, Hicks RJ, Skandarajah A (2018) (18)F-FDG-Avid thyroid incidentalomas: the importance of contextual interpretation. J Nucl Med 59(5):749–755

    Article  Google Scholar 

  18. Grani G, Lamartina L, Cantisani V, Maranghi M, Lucia P, Durante C (2018) Interobserver agreement of various thyroid imaging reporting and data systems. Endocr Connect 7:1–7

    Article  Google Scholar 

  19. Solbiati L, Osti V, Cova L, Tonolini M (2001) Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 11:2411–2424

    Article  CAS  Google Scholar 

  20. Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah N, Amendola S, Morgante SN, Deiana MG, Valabrega S, Toscano V, Papini E (2012) Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab 97:4524–4530

    Article  CAS  Google Scholar 

  21. Magri F, Chytiris S, Capelli V, Gaiti M, Zerbini F, Carrara R, Malovini A, Rotondi M, Bellazzi R, Chiovato L (2013) Comparison of elastographic strain index and thyroid fine-needle aspiration cytology in 631 thyroid nodules. J Clin Endocrinol Metab 98:4790–4797

    Article  CAS  Google Scholar 

  22. Cantisani V, David E, Grazhdani H, Rubini A, Radzina M, Dietrich CF, Durante C, Lamartina L, Grani G, Valeria A, Bosco D, Di Gioia C, Frattaroli FM, D'Andrea V, De Vito C, Fresilli D, D'Ambrosio F, Giacomelli L, Catalano C (2019) Prospective evaluation of semiquantitative strain ratio and quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS classification for thyroid nodule characterization. Ultraschall Med 40:495–503

    Article  Google Scholar 

  23. Russ G, Leboulleux S, Leenhardt L, Hegedüs L (2014) Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J 3:154–163

    Article  Google Scholar 

Download references

Funding

This study did not receive funds.

Author information

Author notes

  1. G. Paone and L. Giovanella share the senior co-authorship.

Authors and Affiliations

  1. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    P. Trimboli, L. Knappe, G. Treglia, T. Ruberto, L. Ceriani, G. Paone & L. Giovanella

  2. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

    P. Trimboli

  3. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland

    G. Treglia

  4. Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    G. Treglia

  5. Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy

    A. Piccardo

  6. Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland

    L. Giovanella

Authors
  1. P. Trimboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Knappe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Treglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Ruberto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Piccardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Ceriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Paone
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Giovanella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Paone.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Also, for this retrospective study, formal consent was not required.

Research involving human participants and/or animals

The study was approved by local ethic committee (ref. BASEC 2018-00685, CE TI 3351).

Informed consent

Informed consent was obtained by all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trimboli, P., Knappe, L., Treglia, G. et al. FNA indication according to ACR-TIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18F-FDG PET/CT. J Endocrinol Invest 43, 1607–1612 (2020). https://doi.org/10.1007/s40618-020-01244-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-020-01244-2

Keywords

Search

Navigation