Clotilde Sparano1, Valentina Verdiani1, Cinzia Pupilli2, Giuliano Perigli3, Benedetta Badii3, Vania Vezzosi4, Edoardo Mannucci1, Mario Maggi1,5, Luisa Petrone6. 1. Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy. 2. Endocrinology Unit, Santa Maria Nuova Hospital, Azienda USL Toscana Centro, 50122, Florence, Italy. 3. Unit of General and Endocrine Surgery, Centre of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. 4. Department of Histopathology and Molecular Diagnostics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 5. Consorzio I.N.B.B., 00136, Rome, Italy. 6. Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 18, 50139, Florence, Italy. luisa.petrone@unifi.it.
Abstract
OBJECTIVE: Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. METHODS: This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). RESULTS: In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. CONCLUSIONS: Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. KEY POINTS: • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the "indeterminate" category negatively influences score's performance in real-life management of thyroid lesions.
OBJECTIVE: Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. METHODS: This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). RESULTS: In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. CONCLUSIONS: Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. KEY POINTS: • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the "indeterminate" category negatively influences score's performance in real-life management of thyroid lesions.
Authors: Franklin N Tessler; William D Middleton; Edward G Grant; Jenny K Hoang; Lincoln L Berland; Sharlene A Teefey; John J Cronan; Michael D Beland; Terry S Desser; Mary C Frates; Lynwood W Hammers; Ulrike M Hamper; Jill E Langer; Carl C Reading; Leslie M Scoutt; A Thomas Stavros Journal: J Am Coll Radiol Date: 2017-04-02 Impact factor: 5.532
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568
Authors: Amit Pandya; Elaine M Caoili; Farah Jawad-Makki; Ashish P Wasnik; Prasad R Shankar; Ron Bude; Megan R Haymart; Matthew S Davenport Journal: AJR Am J Roentgenol Date: 2020-02-18 Impact factor: 3.959