Diagnostic Value of Six Thyroid Imaging Reporting and Data Systems (TIRADS) in Cytologically Equivocal Thyroid Nodules
Abstract
:1. Introduction
2. Material and Methods
2.1. Examined Patients
2.2. Microscopic Examination
2.3. Analysis of US Malignancy Features
2.4. Analyses, Statistical Evaluation
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Parameter | Category of FNA | p | ||||
---|---|---|---|---|---|---|
UC (460) | EC (560) | |||||
BL | MN | FLUS/AUS | SFN/SHT | SM | ||
Number of nodules | 298 | 162 | 329 | 167 | 44 | |
Number of patients | 240 | 141 | 290 | 152 | 43 | |
Age—mean ± SD [years] | 54.7 ± 11.6 | 50.3 ± 13.9 | 53.7 ± 13.6 | 54.1 ± 14.8 | 56.4 ± 14.4 | p < 0.01 MN vs. others |
No/% of males | 18/7.5 | 20/14.2 | 32/11.0 | 15/9.9 | 5/11.6 | NS |
Volume of nodules mean ± SD [cm3] | 7.9 ± 15.4 | 4.6 ± 13.9 | 6.6 ± 13.6 | 5.9 ± 12.9 | 3.2 ± 5.6 | NS |
No of Ben/Mal nodules < 1 cm | 16/0 | 0/47 | 13/1 | 22/2 | 1/11 | |
No/% of cancers | 0/0.0 | 162/100.0 | 35/10.6 | 19/11.4 | 34/77.3 | p < 0.0001 MN & SM vs. others |
No/% of PTCs among cancers | 0/0.0 | 140/86.4 | 20/57.1 | 7/36.8 | 31/91.2 | p < 0.005 MN & SM vs. FLUS/AUS, SFN/SHT |
Other cancers (No/%) | - | FTC (3/1.9) | FTC (7/20.0) | FTC (5/26.3) | FTC (1/2.9) | |
HTC (1/0.6) | HTC (4/11.4) | |||||
PDTC (2/1.2) | HTC (1/2.9) | |||||
AC (1/0.6) | AC (1/2.8) | HTC (7/36.8) | ||||
MTC (13/9.0) | MTC (2/5.7) | MTC (1/2.9) | ||||
ST (2/1.2) | ANG (1/2.8) |
Category of TIRADS/Guideline | Expected T-RoM | Calculated T-RoM | Mal./Ben. Nodules | AUC (95%CI) | |
---|---|---|---|---|---|
3A-T | 1—low-risk thyroid lesion | 1 | 1.6 | 1/62 | 0.763 |
2—intermediate-risk thyroid lesion | 5–15 | 12.0 | 74/541 | (0.728–0.798) | |
3—high-risk thyroid lesion | 50–90 | 54.3 | 175/147 | p < 0.0001 | |
K-T | 2—benign | <3 | 0.0 | 0/51 | 0.788 c (0.755–0.821) p < 0.0001 |
3—low suspicion | 3–15 | 7.8 | 25/295 | ||
4—intermediate | 15–50 | 21.5 | 93/340 | ||
5—high suspicion | >60 | 67.3 | 132/64 | ||
EU-T | 2—benign | 0 | 0.0 | 0/47 | 0.784 d (0.752–0.816) p < 0.0001 |
3—low risk | 2–4 | 6.7 | 17/238 | ||
4—intermediate risk | 6–17 | 15.4 | 58/318 | ||
5—high risk | 26–87 | 54.3 | 175/147 | ||
Kw-T | 3—probably benign | 0 | 2.53 | 3/116 | 0.793 a,b (0.760–0.825) p < 0.0001 |
4a—low suspicion for malignancy | 2–3 | 9.3 | 24/235 | ||
4b—intermediate suspicion for malignancy | 7–38 | 20.5 | 86/333 | ||
4c—moderate concern, not classic for malignancy | 21–92 | 66.7 | 128/64 | ||
5—highly suggestive of malignancy | 89–98 | 81.8 | 9/2 | ||
ACR-T | 1—benign | – | 0.0 | 0/48 | 0.771 (0.738–0.804) p < 0.0001 |
2—not suspicious | <2 | 3.0 | 2/64 | ||
3—mildly suspicious | 5 | 8.9 | 20/204 | ||
4—moderately suspicious | 5–20 | 22.7 | 108/368 | ||
5—highly suspicious | >20 | 64.5 | 120/66 | ||
ATA-T | 1—benign | <1 | 0.0 | 0/1 | 0.778 (0.746–0.811) p < 0.0001 |
2—very low suspicion | <3 | 1.2 | 1/81 | ||
3—low suspicion | 5–10 | 8.4 | 24/260 | ||
4—intermediate suspicion | 10–20 | 19.9 | 72/290 | ||
5—high suspicion | 70–90 | 56.5 | 153/118 |
TIRADS/Guideline Category | EC | UC | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
FLUS/AUS | SFN/SHT | SM | BL & MN | ||||||||||
FNA-RoM: 10.6% | FNA-RoM: 11.4% | FNA-RoM: 77.3% | FNA-RoM: 35.2% | ||||||||||
AUC | T-RoM | FNA-RoM vs. T-RoM | AUC | T-RoM | FNA-RoM vs. T-RoM | AUC | T-RoM | FNA-RoM vs. T-RoM | AUC | T-RoM | FNA-RoM vs. T-RoM | ||
p | p | p | p | p | p | p | p | ||||||
3A-T | 1 | 0.674 <0.005 | 0.0 | NS | 0.613 NS | 0.0 | NS | 0.813 <0.0001 | 50.0 | NS | 0.827 <0.0001 | 0.0 | <0.0001 |
2 | 6.9 | NS | 8.1 | NS | 57.1 | NS | 15.2 | <0.0001 | |||||
3 | 25.0 | <0.005 | 18.2 | NS | 100.0 | <0.05 | 72.4 | <0.0001 | |||||
K-T | 2 | 0.692 <0.0001 | 0.0 | NS | 0.603 NS | 0.0 | NS | 0.803 <0.0001 | 0.0 | NS | 0.864 d,e <0.0001 | 0.0 | <0.0001 |
3 | 5.2 | NS | 7.9 | NS | 60.0 | NS | 6.4 | <0.0001 | |||||
4 | 10.2 | NS | 9.9 | NS | 66.7 | NS | 37.3 | NS | |||||
5 | 34.3 | <0.001 | 22.2 | NS | 100.0 | NS | 82.8 | <0.0001 | |||||
EU-T | 2 | 0.693 <0.0001 | 0.0 | NS | 0.605 NS | 0.0 | NS | 0.851 f <0.0001 | 0.0 | NS | 0.855 d <0.0001 | 0.0 | <0.0001 |
3 | 4.9 | NS | 9.4 | NS | 50.0 | NS | 4.5 | <0.0001 | |||||
4 | 7.9 | NS | 7.6 | NS | 64.3 | NS | 25.4 | <0.05 | |||||
5 | 25.0 | <0.005 | 18.2 | NS | 100.0 | <0.05 | 72.4 | <0.0001 | |||||
Kw-T | 1 | 0.681 <0.0005 | 3.2 | NS | 0.621 h NS | 0.0 | NS | 0.790 <0.0001 | 50.0 | NS | 0.874 a,b,c <0.0001 | 0.0 | <0.0001 |
2 | 6.1 | NS | 8.8 | NS | 57.1 | NS | 9.2 | <0.0001 | |||||
3 | 9.8 | NS | 9.1 | NS | 66.7 | NS | 35.9 | NS | |||||
4 | 32.4 | <0.001 | 25.0 | NS | 100.0 | NS | 82.3 | <0.0001 | |||||
5 | 50.0 | NS | 0.0 | NS | 100.0 | NS | 100.0 | <0.005 | |||||
ACR-T | 1 | 0.655 g <0.005 | 0.0 | NS | 0.593 NS | 0.0 | NS | 0.775 <0.0005 | 0.0 | NS | 0.857 d <0.0001 | 0.0 | <0.0001 |
2 | 0.0 | NS | 0.0 | NS | 66.7 | NS | 0.0 | <0.0001 | |||||
3 | 6.8 | NS | 10.0 | NS | 50.0 | NS | 8.0 | <0.0001 | |||||
4 | 11.0 | NS | 9.6 | NS | 76.2 | NS | 36.5 | NS | |||||
5 | 27.3 | <0.05 | 21.4 | NS | 100.0 | NS | 82.1 | <0.0001 | |||||
ATA-T | 1 | 0.701 <0.005 0.652 * | - | - | 0.589 NS 0.554 * | - | - | 0.810 <0.0001 0.847 * | - | - | 0.843 <0.0001 0.862 * | 0.0 | NS |
2 | 0.0 | NS | 0.0 | NS | 50.0 | NS | 0.0 | <0.0001 | |||||
3 | 5.6 | NS | 8.1 | NS | 55.6 | NS | 7.6 | <0.0001 | |||||
4 | 8.9 | NS | 10.2 | NS | 61.5 | NS | 36.5 | NS | |||||
5 | 28.1 | <0.001 | 17.5 | NS | 100.0 | NS | 71.4 | <0.0001 |
TIRADS/Guideline Threshold Category | SEN | SPC | ACC | PPV | NPV | % of Nodules | SEN | SPC | ACC | PPV | NPV | % of Nodules | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
UC | SM | ||||||||||||
3A-T | 3 | 77.8 | 83.9 | 81.7 | 72.4 | 87.4 | 37.8 | 61.8 | 100.0 | 70.5 | 100.0 | 43.5 | 47.7 |
K-T | 5 | 59.3 | 93.3 | 81.3 | 82.8 | 80.8 | 25.2 | 52.9 | 100.0 | 63.6 | 100.0 | 38.5 | 40.9 |
EU-T | 5 | 77.8 | 83.9 | 81.7 | 72.4 | 87.4 | 37.8 | 61.8 | 100.0 | 70.5 | 100.0 | 43.5 | 47.7 |
Kw-T | 4c | 61.7 | 93.3 | 82.2 | 83.3 | 81.8 | 26.1 | 52.9 | 100.0 | 63.6 | 100.0 | 38.5 | 40.9 |
ACR-T | 5 | 56.8 | 93.3 | 80.4 | 82.1 | 79.9 | 24.3 | 38.2 | 100.0 | 52.3 | 100.0 | 32.2 | 29.5 |
ATA-T | 5 | 67.9 | 85.2 | 79.1 | 71.4 | 83.0 | 33.5 | 58.8 | 100.0 | 68.2 | 100.0 | 41.7 | 45.5 |
FLUS/AUS | SFN/SHT | ||||||||||||
3A-T | 3 | 51.4 | 81.6 | 78.4 | 25.0 | 93.4 | 21.9 | 52.6 | 69.6 | 67.7 | 18.2 | 92.0 | 32.9 |
K-T | 5 | 34.3 | 92.2 | 86.0 | 34.3 | 92.2 | 10.6 | 31.6 | 85.8 | 79.6 | 22.2 | 90.7 | 16.2 |
EU-T | 5 | 51.4 | 81.6 | 78.4 | 25.0 | 93.4 | 21.9 | 52.6 | 69.6 | 67.7 | 18.2 | 92.0 | 32.9 |
Kw-T | 4c | 34.3 | 91.8 | 85.7 | 33.3 | 92.2 | 10.9 | 36.8 | 85.1 | 79.6 | 24.1 | 91.3 | 17.4 |
ACR-T | 5 | 25.7 | 91.8 | 84.8 | 27.3 | 91.2 | 10.0 | 31.6 | 85.1 | 79.0 | 21.4 | 90.6 | 16.8 |
ATA-T | 5 | 45.7 | 86.1 | 81.8 | 28.1 | 93.0 | 17.3 | 36.8 | 77.7 | 73.1 | 17.5 | 90.6 | 23.9 |
TIRADS/Guideline Threshold Category | No/% of nodules | No/% of cancers | No/% of Cancers ≥ 1 cm | No/% of PTC | No/% of FTC | No/% of HCT | No/% of MTC | OR 95%CI * | |
---|---|---|---|---|---|---|---|---|---|
3A-T | 3 | 322/32.2 d,e | 175/70.0 a,b,c,d | 124/65.6 | 148/74.7 a,b,c | 6/37.5 | 5/38.5 | 12/75.0 | 9.6 |
(6.9–13.2) | |||||||||
K-T | 5 | 196/19.6 | 132/52.8 | 88/46.6 | 116/58.6 | 3/18.8 | 3/23.1 | 8/50.0 | 12.0 |
(8.4–17.1) | |||||||||
EU-T | 5 | 322/32.2 d,e | 175/70.0 a,b,c,d | 124/65.6 | 148/74.7 a,b,c | 6/37.5 | 5/38.5 | 12/75.0 | 9.6 |
(6.9–13.2) | |||||||||
Kw-T | 4c | 203/20.3 | 137/54.8 | 91/48.1 | 121/61.1 | 3/18.8 | 3/23.1 | 8/50.0 | 12.6 |
(8.8–17.9) | |||||||||
ACR-T | 5 | 186/18.6 | 120/48.0 | 81/42.9 | 105/53.0 | 2/12.5 | 3/23.1 | 8/50.0 | 9.6 |
(6.7–13.6) | |||||||||
ATA-T | 5 | 271/27.1 | 153/61.2 | 107/56.6 | 134/67.7 | 6/37.5 | 3/23.1 | 8/50.0 | 8.4 |
(16) # | (14) # | (14) # | (2) # | (6.1–11.7) |
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Słowińska-Klencka, D.; Wysocka-Konieczna, K.; Klencki, M.; Popowicz, B. Diagnostic Value of Six Thyroid Imaging Reporting and Data Systems (TIRADS) in Cytologically Equivocal Thyroid Nodules. J. Clin. Med. 2020, 9, 2281. https://doi.org/10.3390/jcm9072281
Słowińska-Klencka D, Wysocka-Konieczna K, Klencki M, Popowicz B. Diagnostic Value of Six Thyroid Imaging Reporting and Data Systems (TIRADS) in Cytologically Equivocal Thyroid Nodules. Journal of Clinical Medicine. 2020; 9(7):2281. https://doi.org/10.3390/jcm9072281
Chicago/Turabian StyleSłowińska-Klencka, Dorota, Kamila Wysocka-Konieczna, Mariusz Klencki, and Bożena Popowicz. 2020. "Diagnostic Value of Six Thyroid Imaging Reporting and Data Systems (TIRADS) in Cytologically Equivocal Thyroid Nodules" Journal of Clinical Medicine 9, no. 7: 2281. https://doi.org/10.3390/jcm9072281