Skip to main content
SpringerLink
Log in

Klassifikation der Schilddrüsensonografie – Vor- und Nachteile einzelner Stratifizierungssysteme

Classification of thyroid sonography – advantages and disadvantages of individual stratification systems

  • Originalien
  • Published:
Journal für Klinische Endokrinologie und Stoffwechsel Aims and scope

Zusammenfassung

In den letzten Jahren wurden weltweit von mehreren Fachgesellschaften Ultraschallklassifizierungssysteme zur Risikostratifizierung von Schilddrüsenknoten entwickelt. Diese beziehen sich alle auf das papilläre Schilddrüsenkarzinom und teilen die Knoten anhand bestimmter sonografischer Kriterien in fünf Risikostufen ein. Abhängig von der Knotengröße sowie diesen spezifischen Ultraschallkriterien wird die Indikation zur Feinnadelpunktion (FNP) gestellt. Bezüglich Spezifität und Sensitivität hinsichtlich Malignomdetektion sind die in Europa und Amerika entwickelten Systeme (EU-TIRADS, ACR-TIRADS, ATA US RSS) ähnlich. Das ACR-TIRADS ist in der Anwendbarkeit zwar das aufwendigste System, zeigt aber in puncto Reduktion unnötiger Feinnadelpunktionen die beste Performance.

Abstract

In recent years, ultrasound classification systems for the risk stratification of thyroid nodules have been developed by several societies worldwide. These all relate to papillary thyroid cancer and classify the nodules into five risk levels based on certain sonographic criteria. Based on this, the indication for fine-needle aspiration (FNA) is made depending on the size of the nodule. The systems developed in Europe and America (EU-TIRADS, ACR-TIRADS, and ATA US RSS) are similar in terms of specificity and sensitivity with regard to malignancy detection. The ACR-TIRADS is the most complex system in terms of usability but shows the best performance in terms of reducing unnecessary FNAs.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Soylemez OUP, Gunduz N (2022) Diagnostic accuracy of five different classification systems for thyroid nodules: a prospective, comparative study. J Ultrasound Med 41(5):1125–1136. https://doi.org/10.1002/jum.15802

    Article  Google Scholar 

  2. Magri F, Chytiris S, Croce L, Molteni M, Bendott G, Gruosso G et al (2020) Performance of the ACR TI-RADS and EU TI-RADS scoring systems in the diagnostic work-up of thyroid nodules in a real-life series using histology as reference standard. Eur J Endocrinol 183(5):521–528

    Article  CAS  Google Scholar 

  3. Maino F, Forleo R, Martinelli M, Fralassi N, Barbato F, Pilli T et al (2018) Prospective validation of ATA and ETA sonographic pattern risk of thyroid nodules selected for FNAC. J Clin Endocrinol Metab 103(6):2362–2368. https://doi.org/10.1210/jc.2018-00274

    Article  PubMed  Google Scholar 

  4. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16(2):109–142. https://doi.org/10.1089/thy.2006.16.109

    Article  PubMed  Google Scholar 

  5. Wartofsky L (2009) Highlights of the American thyroid association guidelines for patients with thyroid nodules or differentiated thyroid carcinoma: the 2009 revision. Thyroid 19(11):1139–1143. https://doi.org/10.1089/thy.2009.1599

    Article  PubMed  Google Scholar 

  6. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (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):1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  7. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M (2009) An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 94(5):1748–1751. https://doi.org/10.1210/jc.2008-1724

    Article  CAS  PubMed  Google Scholar 

  8. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK (2011) Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 260(3):892–899. https://doi.org/10.1148/radiol.11110206

    Article  PubMed  Google Scholar 

  9. Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA (2015) Thyroid ultrasound reporting lexicon: white paper of the ACR thyroid imaging, reporting and data system (TIRADS) committee. J Am Coll Radiol 12(12 Pt A):1272–1279. https://doi.org/10.1016/j.jacr.2015.07.011

    Article  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. https://doi.org/10.1016/j.jacr.2017.01.046

    Article  PubMed  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(5):225–237. https://doi.org/10.1159/000478927

    Article  PubMed  PubMed Central  Google Scholar 

  12. Maino F, Forleo R, Martinelli M, Fralassi N, Barbato F, Pilli T, Capezzone M, Brilli L, Ciuoli C, Di Cairano G, Nigi L, Pacini F, Castagna MG (2018) Prospective validation of ATA and ETA sonographic pattern risk of thyroid nodules selected for FNAC. J Clin Endocrinol Metab 103(6):2362–2368. https://doi.org/10.1210/jc.2018-00274

    Article  PubMed  Google Scholar 

  13. Castellana M, Castellana C, Treglia G, Giorgino F, Giovanella L, Russ G, Trimboli P (2020) Performance of five ultrasound risk stratification systems in selecting thyroid nodules for FNA. J Clin Endocrinol Metab 105(5):1659–1669. https://doi.org/10.1210/clinem/dgz170

    Article  Google Scholar 

  14. Trimboli P, Ngu R, Royer B, Giovanella L, Bigorgne C, Simo R, Carroll P, Russ G (2019) A multicentre validation study for the EU-TIRADS using histological diagnosis as a gold standard. Clin Endocrinol 91(2):340–347

    Article  Google Scholar 

  15. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, Maranghi M, Falcone R, Ramundo V, Cantisani V, Filetti S, Durante C (2019) Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: toward the “right” TIRADS. J Clin Endocrinol Metab 104(1):95–102. https://doi.org/10.1210/jc.2018–01674

    Article  Google Scholar 

  16. Feldkamp J, Führer D, Luster M, Musholt TJ, Spitzweg C, Schott M (2016) Fine needle aspiration in the investigation of thyroid nodules. Dtsch Arztebl Int 113(20):353–359. https://doi.org/10.3238/arztebl.2016.0353

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brauer VFH, Eder P, Miehle K, Wiesner TD, Hasenclever H, Paschke R (2005) Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid 15(10):1169–1175

    Article  CAS  Google Scholar 

  18. Derwahl KM et al (2020) Schilddrüsenknoten: ATA-Leitlinie aus europäischer Sicht. Dtsch Med Wochenschr 145:1227–1235

    Article  Google Scholar 

  19. Niederle MB, Scheuba C, Riss P, Selberherr A, Koperek O, Niederle B (2020) Early diagnosis of medullary thyroid cancer: are calcitonin stimulation tests still indicated in the era of highly sensitive calcitonin Immunoassays? Thyroid 30(7):974–984. https://doi.org/10.1089/thy.2019.0785

    Article  CAS  PubMed  Google Scholar 

  20. Machens A, Holzhausen HJ, Dralle H (2005) The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 103(11):2269–2273. https://doi.org/10.1002/cncr.21055

    Article  PubMed  Google Scholar 

  21. Friedrich-Rust M, Vorlaender C, Dietrich CF, Kratzer W, Blank W, Schuler A, Broja N, Cui XW, Herrmann E, Bojunga J (2016) Evaluation of strain elastography for differentiation of thyroid nodules: results of a prospective DEGUM multicenter study. Ultraschall Med 37(3):262–270. https://doi.org/10.1055/s-0042-104647

    Article  CAS  PubMed  Google Scholar 

  22. Bojunga J, Dauth N, Berner C, Meyer G, Holzer K, Voelkl L, Herrmann E, Schroeter H, Zeuzem S, Friedrich-Rust M (2012) Acoustic radiation force impulse imaging for differentiation of thyroid nodules. Plos One 7(8):e42735. https://doi.org/10.1371/journal.pone.0042735

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Schilddrüsendiagnostik und Nuklearmedizin Gleisdorf, Gleisdorf, Österreich

    Alice Pap, Kerstin Murgg, Eva Petnehazy & Wolfgang Buchinger

  2. Interne Abteilung II, Barmherzige Brüder Graz, Graz, Österreich

    Kerstin Murgg

Authors
  1. Alice Pap
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerstin Murgg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Petnehazy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Buchinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alice Pap.

Ethics declarations

Interessenkonflikt

A. Pap, K. Murgg, E. Petnehazy und W. Buchinger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pap, A., Murgg, K., Petnehazy, E. et al. Klassifikation der Schilddrüsensonografie – Vor- und Nachteile einzelner Stratifizierungssysteme. J. Klin. Endokrinol. Stoffw. 15, 86–93 (2022). https://doi.org/10.1007/s41969-022-00168-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41969-022-00168-x

Schlüsselwörter

Keywords

Search

Navigation