Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

• Published in: European radiology 2022-06, Vol.32 (6), p.3617-3630
• Main Authors: Lin, Yinghe, Lai, Shuiqing, Wang, Peiqing, Li, Jinlian, Chen, Zhijiang, Wang, Long, Guan, Haixia, Kuang, Jian
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Follicular - diagnostic imaging; Adenocarcinoma, Follicular - pathology; Adenoma; Biopsy; Biopsy, Fine-Needle; Classification; Diagnostic Radiology; Head and Neck; Histopathology; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Malignancy; Medicine; Medicine & Public Health; Neoplasms; Neuroradiology; Nodules; Radiology; Retrospective Studies; Risk; Risk Assessment; Thyroid; Thyroid cancer; Thyroid carcinoma; Thyroid gland; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - pathology; Tumors; Ultrasonic imaging; Ultrasonography; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08450-3

Objectives To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy. Methods Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system. Results The area under the curve of each system for distinguishing follicular neoplasms was