Sonographic evaluation of thyroid nodule based on thyroid imaging reporting and data system classification and its correlation with fine needle aspiration cytology findings

Dipta Mandal; Rikta Mallik; Sayantan Dey; Kavyanjali Y. Lama

doi:10.18203/2320-6012.ijrms20241541

Authors

Dipta Mandal Department of Radio-diagnosis, Khatra Subdivision Hospital, West Bengal, India
Rikta Mallik Department of Radio-diagnosis, Bankura Sammilani Medical College, West Bengal, India
Sayantan Dey Department of Radio-diagnosis, Bankura Sammilani Medical College, West Bengal, India
Kavyanjali Y. Lama Department of Radio-diagnosis, Bankura Sammilani Medical College, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241541

Keywords:

USG, ACR- TIRADS, Thyroid nodules, FNAC, Malignant

Abstract

Background: Thyroid nodules, common clinical occurrences, often require diagnostic assessment. Ultrasonography (USG) is primary non-invasive method for detection, with advancing technology enhancing detection capabilities. Fine needle aspiration cytology (FNAC) remains standard but poses risks and expenses. American college of radiology-thyroid image reporting and data system (ACR-TIRADS), introduced in 2017, offers a systematic scoring system based on ultrasound features. This study aims to evaluate USG guided by ACR-TIRADS for accurate nodule classification.

Methods: A 1.5-year study at department of radio-diagnosis of BSMCH evaluated thyroid nodules using high-resolution USG based on ACR-TIRADS criteria, followed by FNAC for selected cases, comparing results for concordance.

Results: Out of 47 thyroid nodules evaluated, 19.1% were malignant and 80% benign. ACR-TIRADS demonstrated sensitivity, specificity, and accuracy of 66.7%, 87.8%, and 82.9%, respectively. Higher ACR-TIRADS categories correlated with an increased risk of malignancy. Suspicious USG features such as hypo-echogenicity, taller-than-wide shape, lobulated margin, and punctate echogenic foci exhibited significant predictive value for malignancy, with varying levels of sensitivity and specificity. Overall, USG parameters demonstrated notable accuracy in identifying malignant nodules.

Conclusions: ACR-TIRADS 2017 reliably predicts thyroid nodule malignancy, reducing unnecessary FNAC procedures, minimizing patient discomfort, and optimizing healthcare resources.

Metrics

Metrics Loading ...

References

Cooper D, Doherty G, Haugen B, Kloos R, Lee S, Mandel S, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.

Hegedüs L. The thyroid nodule. N Engl J Med. 2004;351(17):1764-71.

Desforges J, Mazzaferri E. Management of a solitary thyroid nodule. N Engl J Med. 1993;328(8):553-9.

Tan G. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126(3):226-31.

Gharib H, Papini E. Thyroid nodules: Clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007;36(3):707-35.

Rahbari R, Zhang L, Kebebew E. Thyroid cancer gender disparity. Future Oncol. 2010;6(11):1771-9.

Choi N, Moon WJ, Lee JH, Baek JH, Kim DW, Park SW. Ultrasonographic findings of medullary thyroid cancer: Differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 2011;52(3):312-6.

Hong YJ, Son EJ, Kim EK, Kwak JY, Hong SW, Chang HS. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging. 2010;34(2):127-33.

Kim DW, Lee EJ, Jung SJ, Ryu JH, Kim YM. Role of sonographic diagnosis in managing Bethesda class III nodules. AJNR Am J Neuroradiol. 2011;32(11):2136-41.

Kim DW, Lee YJ, Eom JW, Jung SJ, Ha TK, Kang T. Ultrasound-based diagnosis for solid thyroid nodules with the largest diameter <5 mm. Ultrasound Med Biol. 2013;39(7):1190-6.

Kim DW, Park JS, In HS, Choo HJ, Ryu JH, Jung SJ. Ultrasound-based diagnostic classification for solid and partially cystic thyroid nodules. AJNR Am J Neuroradiol. 2012;33(6):1144-9.

Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178(3):687-91.

Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology. 2008;247(3):762-70.

Lee MJ, Kim EK, Kwak JY, Kim MJ. Partially cystic thyroid nodules on ultrasound: Probability of malignancy and sonographic differentiation. Thyroid. 2009;19(4):341-6.

Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748-51.

Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009;19(11):1257-64.

Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260(3):892-9.

Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, et al. Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Image reporting and characterization system for ultrasound features of thyroid nodules: Multicentric Korean retrospective study. Korean J Radiol. 2013;14(1):110-7.

Xu T, Wu Y, Wu RX, Zhang YZ, Gu JY, Ye XH, et al. Validation and comparision of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination. Endocrine. 2019;64(2):299.

Ha EJ, Na DG, Baek JH, Sung JY, Kim JH, Kang SY. US Fine-Needle Aspiration Biopsy for Thyroid Malignancy: Diagnostic Performance of Seven Society Guidelines Applied to 2000 Thyroid Nodules. Radiology. 2018;287(3):893-900.

Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the “right” TIRADS. J Clin Endocrinol Metabol. 2019;104(1):95.

Srinivas MN, Amogh VN, Gautam MS, Prathyusha IS, Vikram NR, Retnam MK, et al. A prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions. J Clin Imaging Sci. 2016;6(1):98.

Patil YP, Sekhon RK, Kuber RS, Patel CR. Correlation of ACR TIRADS (thyroid imaging, reporting and data system)-2017 and cytological/ Histopathological (HPE) findings in evaluation of thyroid nodules. Int J Health Clin Res. 2020;3(11):6-19.

Debanu D, Dutta S, Tarafdar S, Suvrendu SK, Utpalendu D, Keya B, et al. Comparison between Sonographic Features and Fine Needle Aspiration Cytology with Histopathology in The Diagnosis of Solitary Thyroid Nodule. Indian J Endocrinol Metab. 2020;24(4):349-54.

Siddheshwar KP, Agarwal BD, Mohapatra SSG, Sahu N, Dixit A. Correlation between ultrasound-based ACR TIRADS and bethesda system for reporting thyroid-cytopathology: a prospective study at tertiary care center in eastern India. PARIPEX Indian J Res. 2020;9(3):18-21.

Sankhla DK, Hussein SS, Bererhi H, El Shafie O, Woodhouse NJ, Nirmala V. Are scintigraphy and ultrasonography necessary before fine- needle aspiration cytology for thyroid nodules? SQU J Scientific Res Med Sci. 2001;3(1):29

Bloch M. Fine needle aspiration biopsy of head and neck masses. Otolaryngol Head Neck Surg. 1997;89:62-8.

Garg S, Mohan H, Nagarkar N, Handa U. Role of fine needle aspiration cytology in diagnosis and-management of thyroid lesions: A study on 434 patients. J Cytol. 2008;25(1):13-7.

Hirachand S, Maharjan M, Lakhey M, Thapa R, Kafle S. Accuracy of fine needle aspiration cytology in diagnosis of thyroid swelling. J Pathol Nepal. 2013;3(6):433-6.