Precisión de la PAAF en el reporte histopatológico de cirugía de tiroides

Objetivo: evaluar la precisión de los distintos puntos de corte del score Bethesda de la BAAF, en comparación con el estudio histopatológico para el diagnóstico de patología tiroidea. Métodos: estudio cuantitativo, observacional, de tipo transversal, analítico para la evaluación de pruebas diagnósticas. Incluyó 293 pacientes con patología tiroidea sugestiva de cáncer, que acudieron a Servicio de Cirugía General del Hospital Obrero N° 2 de la Caja Nacional de Salud, durante el periodo de 2019-2022. Se realizó un muestreo no aleatorizado por conveniencia que incluía a todos los pacientes disponibles. Resultados: se afirma la correlación entre las dos variables estudiadas, es decir, entre el puntaje del score Bethesda y el reporte del estudio histopatológico, con un intervalo de confianza (IC) del 95%. Conclusiones: se demuestra que la BAAF tiene alta especificidad en el diagnóstico de cancer de tiroides con reporte Bethesda V y VI, por el contrario, reportes Bethesda menores II, III y IV, descartan el diagnóstico.

Objective: to evaluate the precision of the different cut-off points of the BAAF Bethesda score in comparison with the histopathological study for the diagnosis of thyroid pathology. Methods: quantitative, observational, cross-sectional, analytical study for the evaluation of diagnostic tests. It included 293 patients with thyroid disease suggestive of cancer, who attended the General Surgery Service of Hospital Obrero No. 2 of the National Health Fund, during the period 2019-2022. Non-randomized convenience sampling was performed that included all available patients. Results: the correlation between the two variables studied was confirmed, that is, between the Bethesda score and the histopathological study report, with a confidence interval (CI) of 95%. Conclusions: it is demonstrated that the BAAF has high specificity in the diagnosis of thyroid cancer with Bethesda reports V and VI, on the contrary, minor Bethesda reports II, III, and IV, rule out the diagnosis.

Correlación ultrasonográfica entre volumen tiroideo y ti-rads. Estudio prospectivo / Ultrasonographic correlation between thyroid volume and ti-rads. Prospective study

La comunidad científica se ha preocupado por cuantificar el volumen tiroideo según variables como sexo, edad y deficiencias de yodo asociadas, sin embargo, pese al uso globalizado de TI-RADS para estimación de riesgo de malignidad en la patología tiroidea, no existe suficiente información en relación a si el tamaño de la glándula guarda o no relación con esta escala. Objetivo: comparar el Volumen Tiroideo con TI-RADS en pacientes atendidos en la unidad de ecografía diagnóstica del Centro Clínico Naguanagua en el período enero 2022 - enero 2023. Métodos: estudio observacional-descriptivo de nivel comparativo, con diseño transversal y prospectivo. Muestra no probabilística censal, abarcando la totalidad de los pacientes a los cuales se les efectuó ecografía tiroidea en el período establecido. Se efectuó un registro en cuanto a la cuantificación del volumen de: lóbulo tiroideo derecho, lóbulo tiroideo izquierdo y total de tiroides, TI-RADS, edad y sexo del paciente. Se utilizó el estadístico ANOVA y se empleó el programa Statistical® de licencia libre. Resultados: muestra de 126 pacientes, con edad promedio de 51,71 años ± 1,44, mediana de 53 años. Cuando se comparó el Volumen Total de Tiroides con TI-RADS, se constató que el mayor promedio lo registraron aquellos pacientes clasificados como 4B (p <0,05). Conclusión: aun cuando se registran mayores promedios de volumen total glandular en pacientes con hallazgos nodulares, llama la atención que entre los datos registrados existan pacientes con valores muy similares a lo reportado en la literatura como volúmenes normales en presencia de patología nodular tiroidea(AU)

The scientific community has been concerned with quantifying thyroid volume according to variables such as sex, age, and associated iodine deficiencies; however, despite the global use of TI-RADS to estimate the risk of malignancy in thyroid pathologies, there is not enough information in regarding whether or not the size of the gland is related to this scale. Objective: to compare the Thyroid Volume with TI-RADS in patients treated in the diagnostic ultrasound unit of the Naguanagua Clinical Center in the period January 2022 - January 2023. Methods: observational-descriptive study of a comparative level, with a crosssectional and prospective design. Non-probabilistic census sample, covering all the patients who underwent thyroid ultrasound in the established period. A record was made regarding the quantification of the volume of: right thyroid lobe, left thyroid lobe and total thyroid, TI-RADS, age and sex of the patient. The ANOVA statistic was used and the free license Statistical® program was used. Results: sample of 126 patients, mean age 51.71 ± 1.44 years, median 53 years. When the Total Thyroid Volume was compared with TI-RADS, it was found that the highest mean was registered by those patients classified as 4B (p <0.05). Conclusion: even when higher total glandular volume averages are recorded in patients with nodular findings, it is noteworthy that among the recorded data there are patients with values very similar to those reported in the literature as normal volumes in the presence of thyroid nodular pathology(AU)

Stratifying indeterminate cytology thyroid nodules by combining Thyroid Imaging Reporting and Data Systems (TI-RADS) and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)

Objective@#To determine the risk of malignancy of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) indeterminate Thyroid Nodules (Bethesda III, IV and V) by combining cytologic (TSBRTC) and Thyroid Imaging Reporting and Data Systems (TI-RADS) ultrasonographic features based on final histopathology.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Private Training Hospital. Participants: 551 records. @*Results@#Among 81 eligible participants, 59 out of 84 nodules (70.24%) wer malignant on histopathology. The malignancy risk of Bethesda classification was 60.87% (28 out of 46) for Bethesda III, 57.14% (8 out of 14) for Bethesda IV and 95.83% for Bethesda V. The malignancy risk for TI-RADS categories was 0 % (0/1) for TI-RADS 2, 50% (10 out of 20) for TI-RADS 3, 71.05 % for TI-RADS 4 and 91.67 % for TI-RADS 5. The highest risk of malignancy (100%) was associated with [Bethesda IV/TI-RADS 1, 2, and 3], [Bethesda V/TI-RADS 1, 2 and 3 [Bethesda IV and V/TI-RADS 1, 2 and 3] and [Bethesda IV/TI-RADS 5]. The lowest risk of malignancy (33.33%) was associated with [Bethesda III/TI-RADS1, 2 and 3]. A high Bethesda classification (Bethesda V) was almost 5x more likely to have a malignant anatomorphology compared with Bethesda III (p = .05) while a TI-RADS 4 or 5 category was almost 5x more likely to have a malignant anatomorphology compared to TI-RADS 1, 2 or 3 (p = .026).@*Conclusion@#This study showed that TI-RADS scoring is a sensitive diagnostic classification in recognizing patients with thyroid cancer and combining Bethesda classification and TI-RADS scoring increases the sensitivity in the diagnosis of malignant thyroid nodules. A higher likelihood of malignancy is associated with higher Bethesda classification and TI-RADS scoring.

Ultrasound classification of thyroid nodules: does size matter?

ABSTRACT Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.

Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule

ABSTRACT Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Clasificación ti-rads para diagnóstico y clasificación de los nódulos tiroideos / Ti-rads classification for diagnosis and classification of thyroid nodules

La prevalencia del nódulo tiroideo (NT) en la población general es de entre el 2 al 7% por palpación y de 19 a 76% por ultrasonido. Su incidencia es más alta con la edad, en personas provenientes de áreas con deficiencia de yodo, en mujeres, y después de exposición a radiación. Objetivo: Estudiar distintas fuentes bibliográficas para así establecer la importancia del uso práctico de la clasificación TI-RADS en el nódulo tiroideo. Metodología: Se constituye en una investigación de carácter documental, tanto bibliográfica como digital. Resultados: La importancia del estudio del nódulo tiroideo radica en la necesidad de excluir cáncer, por lo cual, todo nódulo tiroideo >1cm debe ser evaluado. Los nódulos <1cm serán sospechosos cuando se encuentren asociados a factores de riesgo y en presencia de hallazgos ultrasonográficos sugestivos de malignidad. La clasificación TI-RADS de los NT basada en un sistema de puntuación acorde a los criterios ecográficos más relevantes de malignidad tiene una mejor y más fácil aplicación en la práctica diaria. Conclusión: Según los criterios de malignidad y la puntuación asignada en este estudio, la posibilidad de que un NT con un punto en la escala sea maligno es de aproximadamente un 10%, mientras que la probabilidad para aquellos con dos puntos es casi del 50% y para los valorados con tres o cuatro puntos del 85%. Todos los NT con 5 o más puntos son malignos. El presente artículo resume una comparación de referencias bibliográficas para actualización y aplicación de la clasificación TIRADS(AU)

The prevalence of the thyroid nodule (TN) in the general population is between 2 to 7% by palpation and from 19 to 76% by ultrasound. Its incidence is higher with age, in people from iodine-deficient areas, in women, and after exposure to radiation. Objective: To study different bibliographic sources in order to establish the importance of the practical use of the TI-RADS classification in the thyroid nodule. Methodology: It constitutes a documentary research, both bibliographic and digital. Results: The importance of studying the thyroid nodule lies in the need to exclude cancer, therefore, any thyroid nodule> 1cm should be evaluated. Nodules <1cm will be suspicious when associated with risk factors and in the presence of ultrasonographic findings suggestive of malignancy. The TI-RADS classification of NTs based on a scoring system according to the most relevant ultrasound criteria of malignancy has a better and easier application in daily practice. Conclusion: According to the malignancy criteria and the score assigned in this study, the possibility that a TN with one point on the scale is malignant is approximately 10%, while the probability for those with two points is almost 50% and for those valued with three or four points of 85%. All TNs with 5 or more points are malignant. This article summarizes a comparison of bibliographic references for updating and applying the TIRADS classification(AU)

Accuracy of fine needle aspiration cytology and thyroid imaging reporting and data system to predict the nature of nodular goiter and its comparison with postoperative histology

Background: Aim of the study was to find accuracy of pre-operative fine needle aspiration cytology (FNAC) and thyroid imaging reporting and data system (TIRADS) in predicting the nature of nodular goitre and confirming it with post-operative biopsy. Objective of the study was to assess the sensitivity and specificity of FNAC compared with post-operative biopsy and to assess the sensitivity and specificity of TIRADS compared with post-operative biopsy.Methods: This retrospective study was carried out at tertiary hospital, King George Hospital, Visakhapatnam over a period of 1 year from march 2018 to march 2019. Sensitivity and specificity are calculated based on formulae.Results: Sample size calculated with 90% confidence interval for population of vizag is 96, a sample of 100 patients were taken in this study. Of the 100 cases, 16 had thyroid carcinoma. 15 of them were papillary carcinoma and 1 follicular carcinoma. 8 cases matched with cytology report after post op biopsy and 8 we mismatched with cytology report after post op biopsy. The incidence of malignancy in clinically and cytologically benign goitre is 8.69. In our study sensitivity of FNAC is 50%, specificity is 100% and accuracy of test is 92% and TIRADS has a sensitivity of 100% and specificity of 72.62% and an accuracy of 77%.Conclusions: The current study has showed the disparity we see in thyroid neoplasms in FNAC test and TIRADS, which were proved to be different diagnosis in clinical and histopathology, so even if cytology is benign, we can’t rule out malignancy. FNAC and TIRADS combined have more sensitivity and specificity than individual tests.

Carcinoma papilar difuso de tiroides: microcalcificaciones fuera del nódulo tiroideo / Diffuse Papillary Thyroid Carcinoma: Microcalcifications Outside the Thyroid Node

Resumen: Introducción: La incidencia de cáncer papilar de tiroides (PTC) ha aumentado de 1975 a 2015. Basados en criterios publicados, el ultrasonido (US) es muy efectivo para predecir el riesgo de malignidad. Todos estos criterios se enfocan en los nódulos tiroideos; sin embargo, 2% de los casos se pueden presentar como focos ecogénicos difusos sin un nódulo identificable. Caso: Mujer de 17 años con historia de 3 meses con una masa palpable en la región anterior derecha del cuello, sin otros síntomas. El US de cuello revela múltiples focos ecogénicos de distribución difusa en el parénquima tiroideo con un nódulo de 6 mm TI-RADS 5 en el lóbulo izquierdo y ganglio linfáticos con componentes sólidos y quísticos, pérdida del hilio graso y con puntos ecogénicos. Se le realizó tiroidectomía total con linfadenectomía bilateral. Discusión: Las microcalcificaciones son muy sugestivas de CPT. Los ecos puntiformes se correlacionan en patología con una forma de calcificación distrófica llamada cuerpos de Psammoma, los cuales se depositan en tejido no viable. La tiroiditis crónica también puede presentar calcificaciones distróficas. Por lo tanto, un parénquima tiroideo normal con presencia de microcalcificaciones, obliga a realizar una biopsia con aguja fina para descartar CPT. Estudios recientes sugieren que la lobectomía es una opción viable y debe ser la primera elección en CPT localizado (< 2 cm). Sin embargo, esto no se debe realizar en estos pacientes, ya que la presencia de microcalcificaciones difusas nos indica un tamaño del tumor mucho mayor y resultaría en un pronóstico desfavorable. Conclusión: Las microcalcificaciones difusas deben obligar al radiólogo a sospechar la variedad difusa del CPT como primera sospecha diagnóstica.

Abstract: Introduction: The incidence of thyroid papillary cancer (PTC) has increased from 1975 to 2015. Ultrasound is effective for predicting thyroid malignancy based on published criteria. All of these criteria focus on thyroid nodules but also 2% of the cases may appear as diffuse punctuate echogenic foci without an identifiable nodule. Case: A 17-year-old female with a 3-month history of a palpable mass on the right anterior side of the neck without any further symptoms. Neck ultrasound revealed multiple punctuate echogenic foci scattered along the thyroid parenchyma with a 6 mm nodule TI-RADS 5 on the left lobe, lymph nodes with cystic and solid components, loss of echogenic hilum and punctuate echogenic foci. The patient underwent a total thyroidectomy with bilateral lymphadenectomy. The pathology report revealed diffuse distribution of papillary cancer with a nodule on the left lobe and metastatic disease on the lymph nodes. Discussion: Microcalcifications are highly suggestive of PTC. Punctuate echogenic foci correlate in pathology with a form of dystrophic calcifications, called Psammoma bodies, which are deposited in nonviable tissue. Chronic thyroiditis may also present dystrophic calcifications. Thus, a normal thyroid parenchyma with microcalcifications should encourage the radiologist to perform a fine-needle aspiration biopsy (FNAB). Recent studies suggest that lobectomy is a viable option and should be pursued in the setting of localized PTC (<2 cm). A lobectomy should not be performed in patients with diffuse microcalcifications since it would result in an unfavorable outcome. Conclusions: Diffuse microcalcifications should immediately make the radiologist suspect diffuse PTC as a first diagnostic option.

Utilidad para médicos no radiólogos de la clasificación tirads y las características ecográficas de los nódulos tiroideos / Usefulness for non radiologist physicians of tirad classification and ecographic characteristics of thyroid nodules

Dada la mayor accesibilidad a la ecografía tiroidea, se diagnostican más nódulos de forma incidental aumentando su prevalencia al 65% en las tres últimas décadas. Todo ello ha supuesto un aumento de punciones innecesarias. El objetivo de nuestro estudio es identificar la utilidad de la clasificación TIRADS y de las características ecográficas de los nódulos tiroideos para establecer la probabilidad de malignidad de los mismos y seleccionar aquellos sospechosos para realizar la punción y aspiración con aguja fina (PAAF). Se encontró una relación estadísticamente significativa entre la malignidad y nódulo sólido, hipoecogenicidad, márgenes irregulares y microcalcificaciones. Sin embargo, no se encontró relación estadísticamente significativa entre malignidad y número de nódulos, tamaño nodular, diámetro craneocaudal y vascularización central. Asimismo, un 26.1% de los nódulos TIRADS-2 (todos ellos microcarcinomas), un 30% de los TIRADS-3 y un 54 % de los TIRADS-4 fueron malignos (p 0.027). Tanto el TIRADS como las características ecográficas aisladas son útiles para identificar nódulos sugerentes de malignidad.

Owed to the easier accessibility to thyroid ecography, more incidental nodules are discovered reaching their prevalence the 65 % of population in the last three decades. All of it has resulted in a growth of unnecessary fine needle aspirations (FNA). Our study objective is to identify the TIRADS classification utility and the nodules sonographic characteristics to establish their probability of malignancy and to select those suspicious susceptible of FNA. We found a statistically significant relationship between malignancy and solid nodule, hypoechogenicity, irregular margins and microcalcifications. However we didn´t find a relation between malignancy and number, size, shape (taller than wide) and central vascularity. With respect to TIRADS classification, 26,1% of TIRADS-2 (all of them microcarcinomas), 30% of TIRADS-3 and 54% of TIRADS-4 were malignant (p: 0,027). Both of them, TIRADS and individual sonographic characteristics are useful to identify nodules suspicious of malignancy.

Diagnostic efficiency of ultrasound TI-RADS combined with three-dimensional shear wave elastography in thyroid microcarcinoma / 上海交通大学学报（医学版）

Objective:To evaluate the diagnostic value of ultrasound thyroid imaging-reporting and data system (TI-RADS) combined with three-dimensional shear wave elastography (3D-SWE) technique in thyroid microcarcinoma. Methods:From Jun. 2017 to Jan. 2018, 66 patients with 67 thyroid nodules in the Department of Ultrasound of Renji Hospital, Shanghai Jiao Tong University School of Medicine were recruited. All thyroid nodules were classified as TI-RADS 4-5, and the maximum diameter was 5.0-10.0 mm. After routine ultrasound examination, all thyroid nodules were evaluated by TI-RADS classification, 3D-SWE technique, fine-needle aspiration biopsy (FNAB) examination and an additional BRAFV600E gene mutation test. All the nodules were divided into benign group and malignant group according to the results of surgical pathology or fine-needle aspiration combined with BRAFV600E gene detection. The threshold value of the parameters in 3D-SWE for differentiating benign and malignant thyroid nodules was calculated, and the TI-RADS was further adjusted by Young's modulus parameters of the lesion to obtain combined TI-RADS (conventional ultrasound combined with 3D-SWE) for detecting the benign and malignant nodules. Results:Among the 67 thyroid nodules, 38 of them were malignant and 29 were benign. The optimal cut-off point of three-dimensional maximum Young's modulus in sagittal plane (3D-S-Emax) was 24.6 kPa. The area under the curve (AUC) value, sensitivity, specificity and accuracy of 3D-S-Emax were 0.683, 65.8%, 65.5% and 65.7%, respectively. The AUC value for combined TI-RADS was 0.801 and that for conventional TI-RADS was 0.794, without statistical difference. The sensitivity, specificity and accuracy of conventional TI-RADS and combined TI-RADS were 63.2%, 82.8%, 71.6%, and 86.8%, 69.0%, 79.1%, respectively. Only sensitivity of combined TI-RADS was significantly higher than that of conventional TI-RADS (P=0.004). Conclusion:Combined TI-RADS and conventional TI-RADS have similar diagnostic value in thyroid microcarcinoma, while combined TI-RADS has higher diagnostic sensitivity and lower missed diagnosis rate.

Role of ACR-TIRADS in risk stratification of thyroid nodules

Background: This study was performed to prospectively investigate the diagnostic reliability of the daily use of ACR-TIRADS classification system, in differentiating between a benign and a malignant lesion.Methods: In this prospective observational study, 50 patients with thyroid nodules underwent ultrasound examination and fine needle aspiration. The ultrasound studies were evaluated according to the ACR-TIRADS greyscale characteristics of composition, echogenicity, margins, shape, and echogenic foci. Each feature in a particular USG characteristic was scored and ACR-TIRADS categorization done from 1 to 5. This was compared to FNAC/histopathology findings and risk of malignancy was calculated for each feature and ACR-TIRADS category.Results: Of the 50 nodules included in the study, 38 were found to be benign and 12 were found to be malignant. Risk of malignancy for all ultrasound features showed an increasing trend with higher scored feature. Risk of malignancy for various features were as follows: Composition-cystic (0%), spongiform (0%), solid-cystic (0%) and solid (36%); echogenicity-anechoic(0%), hyperechoic (4%), isoechoic (11%), hypoechoic (47%) and markedly hypoechoic (100%); shape-wider-than-tall (21%) and taller-than-wide (66%); margins-smooth (18%), illdefined (0%), lobulated/irregular (38%) and extrathyroid extension (100%); echogenic foci-none (13%), large comet-tail artefacts (0%), macrocalcification (42%), rim calcification (50%) and punctate echogenic foci (50%). Amongst ACR-TIRADS(TR) categories TR1, TR2 and TR3 had 0% risk while TR4 had 30% and TR5 had 56% risk of malignancy with p value of 0.001.Conclusions: ACR-TIRADS is a high specific, accurate classification system for categorizing the thyroid nodules based on ultrasound features, for assessing the risk of malignancy.

Study on the comparison of diagnostic of K-TIRADS, ACR-TIRADS and ATA in CAD and diagnosis of thyroid nodules by computer-assisted ultrasonography / 中华超声影像学杂志

Objective@#To explore the diagnostic efficiency of K-TIRADS, ACR-TIRADS and ATA risk stratification in computer-aided detection and diagnosis(CAD) software and the application value of CAD-assisted ultrasound physicians in diagnosing thyroid nodules.@*Methods@#One hundred and ninety-two thyroid nodules with postoperative pathological results were retrospectively analyzed. All of them were graded by K-TIRADS, ACR-TIRADS and ATA with CAD software, and the best guide was recognized by calculating the area under the ROC curve, sensitivity and specificity. Then, based on the best guidelines for the classification criteria, the double-blind method was used to compare the ability of the same ultrasonologist to diagnose thyroid nodules before and after CAD.@*Results@#The AUC value of K-TIRADS, ACR-TIRADS, ATA was 0.88, 0.77, 0.62 respectively in the CAD software. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in the specificity between K-TIRADS and ATA(P=0.176), which were both higher than ACR-TIRADS with statistically significant differences (P<0.05). The AUC value of the diagnosis among CAD itself, ultrasound physicians and physicians combined CAD was 0.88, 0.80, 0.93, respectively. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in the sensitivity between CAD itself and physicians combined CAD(P=0.163), which were both higher than ultrasound physicians with statistical significant differences(P<0.05). Among ultrasound physicians, CAD itself and physicians combined CAD, the difference in specificity between the two groups was statistically significant(P<0.05).@*Conclusions@#All the three risk stratification systems of thyroid ultrasound in CAD software have good diagnostic values, among which K-TIRADS has the largest AUC. The CAD software can assist ultrasound physicians to improve the thyroid nodule diagnostic performance, and has a good clinical application prospect.

Study on the comparison of diagnostic of K‐TIRADS ,ACR‐TIRADS and ATA in CAD and diagnosis of thyroid nodules by computer‐assisted ultrasonography / 中华超声影像学杂志

Objective To explore the diagnostic efficiency of K‐T IRADS ,ACR‐T IRADS and AT A risk stratification in computer‐aided detection and diagnosis ( CAD ) software and the application value of CAD‐assisted ultrasound physicians in diagnosing thyroid nodules . Methods One hundred and ninety‐two thyroid nodules with postoperative pathological results were retrospectively analyzed . All of them were graded by K‐T IRADS ,ACR‐T IRADS and A T A with CAD software ,and the best guide was recognized by calculating the area under the ROC curve ,sensitivity and specificity . T hen ,based on the best guidelines for the classification criteria , the double‐blind method was used to compare the ability of the same ultrasonologist to diagnose thyroid nodules before and after CAD . Results T he AUC value of K‐T IRADS , ACR‐T IRADS ,A T A was 0 .88 ,0 .77 ,0 .62 respectively in the CAD software . T he difference between the two groups was statistically significant ( P ＜0 .05 ) . T here was no significant difference in the specificity between K‐T IRADS and A T A ( P ＝0 .176 ) ,w hich were both higher than ACR‐T IRADS with statistically significant differences ( P ＜ 0 .05 ) . T he AUC value of the diagnosis among CAD itself , ultrasound physicians and physicians combined CAD was 0 .88 ,0 .80 ,0 .93 ,respectively . T he difference between the two groups was statistically significant ( P ＜0 .05) . T here was no significant difference in the sensitivity between CAD itself and physicians combined CAD ( P ＝0 .163 ) ,w hich were both higher than ultrasound physicians with statistical significant differences( P ＜0 .05) . Among ultrasound physicians ,CAD itself and physicians combined CAD ,the difference in specificity between the two groups was statistically significant ( P ＜0 .05) . Conclusions All the three risk stratification systems of thyroid ultrasound in CAD software have good diagnostic values ,among w hich K‐T IRADS has the largest AUC . T he CAD software can assist ultrasound physicians to improve the thyroid nodule diagnostic performance , and has a good clinical application prospect .

Efficiency comparison of Kwak and ACR ( 2017 ) Thyroid Imaging Reporting and Data System ( TI‐RADS) classification :a polycentric retrospective study / 中华超声影像学杂志

Objective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .

The value of ultrasound-guided fine needle aspiration combined with detection of BRAF V600E in diagnosis of benign and malignant thyroid nodules / 中华超声影像学杂志

Objective@#To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA) combined with detection of BRAF V600E and thyroid imaging reporting and data system(TI-RADS) in diagnosis of benign and malignant thyroid nodules.@*Methods@#In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin (HE) staining and cytological diagnosis and detection of BRAF V600E mutation.@*Results@#①BRAF V600E mutation was found in 71 (71/123) nodules with histologic confirmation of papillary-thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US-FNA, and the difference was statistically significant(P<0.001). ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion(χ2=8.44, P=0.004), and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicular carcinoma, and 3 nodules were benign ones.@*Conclusions@#US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

Screening of benign and malignant thyroid nodules in 5 196 physical examination population / 中华肿瘤杂志

Objective@#To investigate the distribution characteristics of thyroid nodules and thyroid cancer in physical examination population in Tianjin, and report the outcome of ultrasonography in detection of thyroid nodules.@*Methods@#Enrolled all of physical examination population in our hospital from Jan 1, 2014 to Dec 31, 2014 as our study subjects then the thyroid gland lesions were screened by ultrasound diagnostic technique. The risk assessment of benign and malignant thyroid nodules was assessed by ultrasonography and thyroid imaging reporting and data system (TI-RADS), and the individuals were followed up for 1 year.@*Results@#Among the 5 196 cases, the patients with thyroid nodules was 2 068 cases (39.80%). The thyroid nodules was 35.04% in male and 44.78% in female subjects, lower in females than in male cases (P<0.001). 18 cases of thyroid cancer patients were detected (0.35%). The thyroid cancer rate were 0.34% and 0.36% in male and female respectively (P>0.05). Thyroid nodules increased with age, but the thyroid cancer patients were mainly concentrated in the 30 to 39 years old group and 50 to 59 years old group. All of the thyroid cancer patients underwent surgical treatment, better differentiation thyroid papillary carcinoma (17 cases) in major, most were early stage cancer and micro-cancer, possessing relatively low risk of recurrence. The sensitivity, specificity and accuracy of ultrasonography and TI-RADS diagnosis of thyroid cancer was 72.22%, 98.94% and 98.85%.@*Conclusions@#The detection rate of thyroid nodules in our population is close to 40%, and there are differences between sexes and ages. Ultrasonography and TI-RADS association is an efficient method to detect the nodules in thyroid.

The clinical characteristics and pathological results of the thyroid nodules by US-FNAB:a study of 1,241 cases / 中国肿瘤临床

Objective:To explore the diagnostic value of ultrasound-guided fine needle aspiration biopsy(US-FNAB)for thyroid nod-ules.Methods:The clinical characteristics and cytopathological diagnosis of patients with thyroid nodules in Tianjin Medical University General Hospital were analyzed retrospectively;the results of the cytopathological and pathological diagnoses were compared and an-alyzed.Results:Of the 1,241 US-FNAB samples,the ratio of men to women with thyroid nodules was 1:3.83(257/984).The incidence of thyroid nodules gradually increased from the age of 20 years and declined after the age of 60 years.The nodules,which were less than or equal to 1.0 cm in size,accounted for 51.57%(640 cases),and Thyroid Imaging Reporting And Data System(TIRADS)classifica-tion 4 accounted for 86.38%(1 072 cases).Of cyto-pathological diagnoses,22.00%(273 cases)were non-diagnostic,9.75%(121 cases) were benign,30.62%(380 cases)were atypia with undetermined significance,32.15%(399 cases)were suspicious for malignancy,and 5.48%(68 cases)were malignant.In the 302 patients who underwent surgery,the number of cases of clear diagnoses,unavailable di-agnoses,and atypia of undetermined significance were 203,21,and 78,respectively.In the 203 cases of clear diagnoses,the sensitivi-ty,specificity,positive predictive value,negative predictive value,precision,and misdiagnoses following US-FNAB of thyroid nodules were 100.00%(201/201),50.00%(1/2),99.50%(201/202),100.00%(1/1),99.51%(202/203),and 0.49%(1/203),respectively.In the 78 cases that were atypia of undetermined significance,the malignancy rate was 70.51%.Whether the atypia of undetermined signifi-cance was malignant or not was related to the TIRADS classification(P<0.05),and not related to the age,sex,tumor size,or location of the nodules(P>0.05).Conclusions:US-FNAB has high diagnostic value for thyroid nodules and is worthy of being popularized widely.If it replaced some intra-operative frozen sectioning procedures,it may reduce intra-operative waiting time and financial burden of pa-tients.

Caracterización de los pacientes con diagnóstico de cáncer de la glándula tiroides atendidos en Hospital Escuela Dr. Roberto Calderón Gutiérrez, Managua- Nicaragua durante el año 2016 / Characterization of patients diagnosed with thyroid gland cancer treated at Dr. Roberto Calderón Gutiérrez School Hospital, Managua- Nicaragua during 2016

OBJETIVO. Caracterizar a los pacientes con diagnóstico de cáncer de la glándula tiroides atendidos en el Hospital Escuela Roberto Calderón Gutiérrez. Managua, Nicaragua en el año 2016. DISEÑO. Se realizó un estudio de descriptivo, retrospectivo de corte transversal en 65 pacientes con diagnóstico de cáncer de la glándula tiroides obteniendo la información contemplada en los expedientes clínicos. RESULTADOS. De los 65 casos estudiados fueron 47.7% en edades entre los 30 y 50 años, 72.3% del sexo femenino, 41.5% amas de casa como principal ocupación, antecedentes de cáncer de tiroides en el paciente en el 23.1% 92.3% presentaron masa en cuello como manifestación clínica con nódulos con diámetros entre 1 y 4 cm (63.1%), periodo de evolución de la enfermedad de 2 a 5 años, cáncer recurrente en 15 casos, 81.5% de los pacientes con función tiroidea normal, 93.4% clasificación TI-RADS y 92.7% clasificación de sugerente de malignidad o malignos con abordaje quirúrgico en el 100% de los casos y Yodoterapia en el 41.7%. CONCLUSIÓN. El cáncer de tiroides tiene una tendencia ascendente en los últimos años al igual que el resto de cánceres por lo que debe estandarizarse el abordaje diagnóstico para la detección en etapas tempranas

Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

ABSTRACT Objective The aim of this study was to describe the ultrasound features of benign and malignant thyroid nodules and evaluate the likelihood of malignancy associated with each feature according to the Bethesda System for Reporting Thyroid Cytopathology and histopathology. With this analysis, we propose a new TI-RADS classification system. Materials and methods The likelihood of malignancy from ultrasound features were assessed in 1413 thyroid nodules according to the Bethesda System for Reporting Thyroid Cytopathology and histopathological findings. A score was established by attributing different weights to each ultrasound feature evaluated. Results Features positively associated with malignancy in bivariate analysis received a score weight of +1. We attributed a weight of +2 to features which were independently associated with malignancy in a multivariate analysis and +3 for those associated with the highest odds ratio for malignancy (> 10.0). Hence, hypoechogenicity (graded as mild, moderate or marked, according to a comparison with the overlying strap muscle), microcalcification and irregular/microlobulated margin received the highest weights in our scoring system. Features that were negatively associated with malignancy received weights of -2 or -1. In the proposed system a cutoff score of 2 (sensitivity 97.4% and specificity 51.6%) was adopted as a transition between probably benign (TI-RADS 3) and TI-RADS 4a nodules. Overall, the frequency of malignancy in thyroid nodules according to the categories was 1.0% for TI-RADS 3, 7.8% for TI-RADS 4a, 35.3% for TI-RADS 4b, and 84.7% for TI-RADS 5. Conclusion A newly proposed TI-RADS classification adequately assessed the likelihood of malignancy in thyroid nodules.

Correlação entre as classificações de TIRADS e Bethesda em punções aspirativas por agulha fina de tireóide / Correlation between TIRADS and Bethesda classification in fine needle aspiration biopsy of the thyroid

Verificar se a nova classificação TIRADS possui correlação com o sistema Bethesda. METODOLOGIA: As informações foram coletadas a partir de prontuário eletrônico do Serviço de Patologia (Centro de Patologia de Curitiba) no Hospital Nossa Senhora das Graças a partir dos laudos citopatológicos com resultados catalogados pelo Sistema Bethesda e que conste a informação da classificação do nódulo tireoidiano pelo TIRADS, compreendidos entre 22 de junho de 2013 e 22 de setembro 2013. RESULTADOS: Na classificação de TIRADS houve prevalência de TIRADS 2 (benignidade) com 82 casos (72,5%). Já no sistema Bethesda houve prevalência da categoria II (benignidade) com 89 casos (78,8%). Ao se estabelecer a correlação entre a classificação radiológica e citológica, observou-se que a grande maioria foi catalogada como benigna à ecografia, sendo que houve correspondência do ponto de vista citológico. Naqueles com diagnóstico TIRADS 4, 10 (37%) foram benignos, enquanto 17 (63%) não benignos. Já TIRADS 5, tivemos apenas um caso, e este foi classificado como não benigno pelo laudo citológico. CONCLUSÃO: Houve correlação significativa entre o sistema Bethesda e a classificação TIRADS

OBJECT: The purpose of this study is to verify that the new classification TIRADS has correlation with the Bethesda system. METHODS: Data were collected from electronic medical records of the Pathology Service (Curitiba Pathology Centre) at the Hospital Nossa Senhora das Graças from the cytopathology reports with results classified by the Bethesda System and the record information from the classification of thyroid nodules by TIRADS, ranging from June 22, 2013 and September 22, 2013. RESULTS In classification TIRADS prevalence was TIRADS 2 (benign) with 82 cases (72.5%). Bethesda already in the system was prevalent category II (benign) with 89 cases (78.8%). To establish the correlation between cytological and radiological classification, it was observed that the vast majority was cataloged as benign at ultrasound, and there was correspondence from a cytological viewpoint. Those with diagnosis TIRADS 4, 10 (37%) were benign, while 17 (63%) did not benign. Already TIRADS 5, we had only one case, and this was not classified as benign by cytological report. CONCLUSION: Significant correlation has been observed between Bethesda system and TIRADS classification