Ultrasonographic Characteristics of Malignant Thyroid Nodules without Indication for Fine Needle Aspiration by the ACR-TIRADS system
DOI:
https://doi.org/10.24220/2318-0897v33a2025e8608Keywords:
Biopsy, Fine-Needle, Thyroid Carcinoma, UltrasonographAbstract
Objective
Evaluate the characteristics of nodules submitted to fine needle aspiration with or without indication of American College of Radiology Thyroid Imaging Reporting and Data System and ultrasound characteristics of malignant nodules without indication.
Methods
Retrospective observational study at Dona Helena hospital in Joinville-SC, from January 2011 to December 2021. Cases of thyroidectomy that had or not Fine Needle Aspiration indication by the Thyroid Imaging Reporting and Data Systemm and the ultrasound profile of nodules without indication were compared. In the adjusted odds ratio calculus, the 95% confidence interval was used.
Results
Nodules were divided into 2 groups: with (n=203/56.38%) and without (n =157/43.61%) indication of fine needle aspiration by the Thyroid Imaging Reporting and Data System. In the adjusted odds ratio calculus for fine needle aspiration indication or not, there was no impact between the categories Bethesda 4-6 or anatomopathological with malignant characteristics. There were 105 carcinomas without indication of fine needle aspiration. Characteristics that increased the chance of malignancy: nodule less than 1 cm (CR=2.916 95% CI 1.377-6.177), solid form (CR=3.83 95% CI 1.894-7.747), hypoechoic echogenicity (CR=4.593 95% CI 2.214-9.527) and TR4 score (CR=7.074 95% CI 2.922-17.111).
Conclusion
Indication of fine needle aspiration by the American College of Radiology Thyroid Imaging Reporting and Data System did not increased diagnoses of carcinomas. 64.3% of nodules without indication of fine needle aspiration were neoplasias. Characteristics that facilitated this identification: being less than 1 cm, solid, hypoechoic, and classified as TI-RADS 4.
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References
Grani G, Sponziello M, Pecce V, Ramundo V, Durante C. Contemporary thyroid nodule evaluation and management. J Clin Endocrinol Metab [Internet]. 2020;105(9):2869-83. Available from: https://doi.org/10.1210/clinem/dgaa322
Simões, DA. Avaliação de malignidade em nódulos tireoidianos menores que 1 cm por ultrassonografia [monograph]. João Pessoa: Universidade Federal da Paraíba; 2012.
Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, et al. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. Arq Bras Endocrinol Metabol [Internet]. 2013;57(4):240-64. https://doi.org/10.1590/s0004-27302013000400002
Singh Ospina N, Brito JP, Maraka S, Espinosa de Ycaza AE, Rodriguez-Gutierrez R, Gionfriddo MR, et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine [Internet]. 2016;53(3):651-61. https://doi.org/10.1007/s12020-016-0921-x
Jabar ASS, Koteshwara P, Andrade J. Diagnostic reliability of the Thyroid Imaging Reporting and Data System (TI-RADS) in routine practice. Pol J Radiol [Internet]. 2019;84:e274-80. https://doi.org/10.5114/pjr.2019.86823
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol [Internet]. 2017;14(5):587-95. https://doi.org/10.1016/j.jacr.2017.01.046
Hoang JK, Middleton WD, Tessler FN. Update on ACR TI-RADS: Successes, challenges, and future directions, from the AJR special series on Radiology reporting and data systems. Am J Roentgenol [Internet]. 2021;216(3):570-8. https://doi.org/10.2214/AJR.20.24608
Ha EJ, Na DG, Moon W-J, Lee YH, Choi N. Diagnostic performance of ultrasound-based risk-stratification systems for thyroid nodules: Comparison of the 2015 American Thyroid Association guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology guidelines. Thyroid [Internet]. 2018;28(11):1532-7. https://doi.org/10.1089/thy.2018.0094
Tessler FN, Middleton WD, Grant EG. Thyroid imaging reporting and data system (TI-RADS): a user’s guide. Radiology [Internet]. 2018;287(1):29-36. https://doi.org/10.1148/radiol.2017171240
Botz B, Smith D. Acr thyroid imaging reporting and data system (Acr ti-rads). Radiopaedia.org; 2017. https://doi.org/10.53347/rID-52374.
Cibas ES, Ali SZ. The 2017 bethesda system for reporting thyroid cytopathology. Thyroid [Internet]. 2017;27:1341-6. https://doi.org/10.1089/thy.2017.0500.
Leni D, Seminati D, Fior D, Vacirca F, Capitoli G, Cazzaniga L, et al. Diagnostic performances of the ACRTIRADS system in thyroid nodules triage: A prospective single center study. Cancers (Basel) [Internet]. 2021;13(9). https://doi.org/10.3390/cancers13092230
Trimboli P, Knappe L, Treglia G, Ruberto T, Piccardo A, Ceriani L, et al. FNA indication according to ACRTIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18F-FDG PET/CT. J Endocrinol Invest [Internet]. 2020;43(11):1607-12. https://doi.org/10.1007/s40618-020-01244-2
Kurian EM, Dawlett M, Wang J, Gong Y, Guo M. The triage efficacy of fine needle aspiration biopsy for follicular variant of papillary thyroid carcinoma using the Bethesda reporting guidelines. Diagn Cytopathol [Internet]. 2012 [cited 2022 Oct 18];40 Suppl 1(S1):E69-73. Available from: https://pubmed.ncbi.nlm.nih.gov/21538966/
Pires AT, Mustafa MM, Magalhães MOG. TI-RADS-ACR 2017: ensaio iconográfico. Radiologia Brasileira [Internet]. 2022 [cited 2022 Oct 18];55(1):47-53. Available from: https://rb.org.br/detalhe_aop.asp?id=3377&idioma=Portugues
Middleton WD, Teefey SA, Tessler FN, Hoang JK, Reading CC, Langer JE, et al. Analysis of malignant thyroid nodules that do not meet ACR TI-RADS criteria for fine-needle aspiration. Am J Roentgenol [Internet]. 2021;216(2):471-8. https://doi.org/10.2214/AJR.20.23123
Zhang F, Chen W. Sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and diagnostic performance of the 2017 ACR TI-RADS in FV-PTC. Endocrine [Internet]. 2020 [cited 2022 Oct 18];67(2):379-86. Available from: https://pubmed.ncbi.nlm.nih.gov/31919771/
Suteau V, Munier M, Briet C, Rodien P. Sex bias in differentiated thyroid cancer. Int J Mol Sci [Internet]. 2021;22(23):12992. https://doi.org/10.3390/ijms222312992
Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes [Internet]. 2017;24(5):332-6. https://doi.org/10.1097/med.0000000000000359
Tappouni RR, Itri JN, McQueen TS, Lalwani N, Ou JJ. ACR TI-RADS: Pitfalls, solutions, and future directions. Radiographics [Internet]. 2019 [cited 2022 Oct 18];39(7):2040-52. Available from: https://pubmed.ncbi.nlm.nih.gov/31603734/
Pagano L, Falco EC, Bisceglia A, Gambella A, Rossetto R, Garberoglio S, et al. Retrospective analysis of the ultrasound features of resected thyroid nodules. Endocrine [Internet]. 2021;72(2):486-94. https://doi.org/10.1007/s12020-020-02495-y
Suh J, Choi HS, Kwon A, Chae HW, Kim H-S. Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy. Eur J Pediatr [Internet]. 2020;179(2):317–25. https://doi.org/10.1007/s00431-019-03507-4
Şahin M, Oguz A, Tuzun D, Akkus G, Törün GI, Bahar AY, et al. Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules. Adv Clin Exp Med [Internet]. 2021 [cited 2022 Oct 18];30(11):1133–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34510845
Zhuang Y, Li C, Hua Z, Chen K, Lin JL. A novel TIRADS of US classification. Biomed Eng Online [Internet]. 2018 [cited 2022 Oct 18];17(1):82. https://doi.org/10.1186/s12938-018-0507-3
Kant R, Davis A, Verma V. Thyroid nodules: Advances in evaluation and management. Am Fam Physician [Internet]. 2020 [cited 2022 Oct 18];102(5):298-304. https://pubmed.ncbi.nlm.nih.gov/32866364/
Grani G, Lamartina L, Ramundo V, Falcone R, Lomonaco C, Ciotti L, et al. Taller-than-wide shape: A new definition improves the specificity of TIRADS systems. Eur Thyroid J [Internet]. 2020 [cited 2022 Oct 18];9(2):85-91. http://dx.doi.org/10.1159/000504219
Soyer Güldoğan E, Ergun O, Taşkın Türkmenoğlu T, Yılmaz KB, Akdağ T, Özbal Güneş S, et al. The impact of TI-RADS in detecting thyroid malignancies: a prospective study. Radiol Med [Internet]. 2021 [cited 2022 Oct 18];126(10):1335-44. Available from: https://pubmed.ncbi.nlm.nih.gov/34176050/