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Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis

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Abstract

Objectives

To summarize and compare unnecessary biopsy rates and diagnostic performance in the examination of thyroid nodules according to four representative US-based risk stratification systems.

Methods

MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating unnecessary biopsy rates according to at least one of the following guidelines: ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS. The unnecessary biopsy rates for each risk stratification system were pooled using a random-effects model. Meta-regression analyses were performed to explore heterogeneity. Diagnostic odds ratios (DORs) for the appropriate selection of thyroid nodules for fine-needle aspiration were also pooled using a bivariate random-effects model.

Results

Eight articles including 13,092 thyroid nodules met the eligibility criteria and were included. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22–29%), 51% (95% CI, 44–58%), 38% (95% CI, 16–66%), and 55% (95% CI, 42–67%), respectively. The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001), and also lower than that of EU-TIRADS, but not reaching statistical significance (p = .087). The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6–9.6), 6.3 (95% CI, 4.5–8.8), and 4.5 (95% CI, 1.7–11.6), respectively, with the differences not being statistically significant.

Conclusions

ACR-TIRADS showed a lower unnecessary biopsy rate than the other risk stratification systems albeit DOR was comparable between ACR-TIRADS, ATA, and K-TIRADS. Future revisions of each system should be made by referring to ACR-TIRADS to reduce unnecessary biopsy rates.

Key Points

• The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22–29%), 51% (95% CI, 44–58%), 38% (95% CI, 16–66%), and 55% (95% CI, 42–67%), respectively.

• The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001).

• The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6–9.6), 6.3 (95% CI, 4.5–8.8), and 4.5 (95% CI, 1.7–11.6), respectively, with the differences not being statistically significant.

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Abbreviations

ACR:

American College of Radiology

ATA:

American Thyroid Association

DOR:

Diagnostic odds ratio

EU-TIRADS:

2017 European Thyroid Association TIRADS

FNAB:

Fine-needle aspiration biopsy

K-TIRADS:

2016 Korean Thyroid Association/Korean Society of Thyroid Radiology (KTA/KSThR) TIRADS

TIRADS:

Thyroid Imaging Reporting and Data System

US:

Ultrasound

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, South Korea

    Pyeong Hwa Kim, Chong Hyun Suh, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi & Jeong Hyun Lee

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Correspondence to Jung Hwan Baek.

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Institutional Review Board approval was not required for this study because this study is a systematic review and meta-analysis.

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Kim, P.H., Suh, C.H., Baek, J.H. et al. Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis. Eur Radiol 31, 2877–2885 (2021). https://doi.org/10.1007/s00330-020-07384-6

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