Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Acquisition of Data
2.3. US Examination
2.4. Modified TIRADS Classification
2.5. Fine Needle Aspiration (FNA)
2.6. Standard of Reference
2.7. Statistical Analysis
3. Results
3.1. Performance of M-TIRADS and K-TIRADS Using FNA as Reference Standard
3.2. Results of M-TIRADS in the Subgroup of Surgically Treated Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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US Feature | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | OR |
---|---|---|---|---|---|
Marked hypoechogenicity | 64.86 | 94.32 | 45.28 | 97.37 | 11.43 |
Microcalcification | 67.57 | 90.02 | 32.89 | 97.46 | 6.77 |
Irregular margins | 75.68 | 93.74 | 46.67 | 98.16 | 12.09 |
AP > LL | 29.73 | 98.63 | 61.11 | 95.05 | 21.07 |
Lymphadenopathy | 19.22 | 100 | 100 | 94.28 | 177.32 |
M-TIRADS | 93.02 (80.94–98.54) | 81.31 (77.69–84.57) | 29.2 (21.75–37.57) | 99.29 (97.95–99.85) | 18.62 |
Categories | Based on TIRADS by Kwak (n = 424) | Based on M-TIRADS (n = 460) |
---|---|---|
TIRADS categories | - | - |
TIRADS 3 benign/malignant | 172/1 | 320/3 |
TIRADS 4A benign/malignant | 168/2 | 72/5 |
TIRADS 4B benign/malignant | 42/11 | 20/12 |
TIRADS 4C benign/malignant | 9/7 | - |
TIRADS 5 benign/malignant | 0/12 | 5/23 |
Risk of malignancy | - | - |
TIRADS 2 | 0 | 0 |
TIRADS 3 | 0.4 | 0.9 |
TIRADS 4A | 0.8 | 6.5 |
TIRADS 4B | 11.7 | 37.5 |
TIRADS 4C | 23.3 | - |
TIRADS 5 | 75 | 82.1 |
M-TIRADS | Cytology | Histology | ||
---|---|---|---|---|
Bethesda Category | Cases | Category | Cases | |
M-TIRADS 2 | Benign | 7 | Benign | 6 |
Lymphoma | 1 | |||
M-TIRADS 3 | Nondiagnostic | 7 | Benign | 7 |
Benign | 25 | Benign | 22 | |
Thyroiditis | 1 | |||
Follicular carcinoma | 2 | |||
Follicular pathology | 4 | Benign | 2 | |
Papillary carcinoma | 2 | |||
Follicular neoplasia | 1 | Benign | 1 | |
Suspicious | 3 | Papillary carcinoma | 2 | |
Thyroiditis | 1 | |||
Malignant | 1 | Papillary carcinoma | 1 | |
No cytology | 3 | Benign | 3 | |
M-TIRADS 4A | Nondiagnostic | 3 | Benign | 2 |
Papillary carcinoma | 1 | |||
Benign | 5 | Benign | 5 | |
Follicular pathology | 1 | Benign | 1 | |
Follicular neoplasia | 1 | Papillary carcinoma | 1 | |
Suspicious | 5 | Benign | 1 | |
Papillary carcinoma | 3 | |||
Medullar carcinoma | 1 | |||
Malignant | 4 | Benign | 2 | |
Papillary carcinoma | 2 | |||
M-TIRADS 4B | Nondiagnostic | 2 | Benign | 2 |
Benign | 2 | Benign | 2 | |
Follicular pathology | 1 | Benign | 1 | |
Follicular neoplasia | 2 | Papillary carcinoma | 1 | |
Follicular carcinoma | 1 | |||
Suspicious | 6 | Benign | 3 | |
Papillary carcinoma | 2 | |||
Thyroiditis | 1 | |||
Malignant | 10 | Papillary carcinoma | 10 | |
No cytology | 1 | Benign | 1 | |
M-TIRADS 5 | Nondiagnostic | 2 | Benign | 1 |
Anaplastic carcinoma | 1 | |||
Benign | 2 | Benign | 2 | |
Suspicious | 5 | Papillary carcinoma | 4 | |
Thyroiditis | 1 | |||
Malignant | 15 | Benign | 2 | |
Papillary carcinoma | 10 | |||
Medullar carcinoma | 3 | |||
No cytology | 1 | Papillary carcinoma | 1 |
Nr. | Bethesda Category | US Echogenicity | Histology Result |
---|---|---|---|
1. | Follicular pathology | Hypo | Papillary carcinoma (follicular) |
2. | Suspicious | Hypo | Papillary carcinoma |
3. | Malignant | Hypo | Papillary carcinoma (follicular), multifocal |
4. | Benign | Iso | Microfollicular carcinoma |
5. | Benign | Iso | Papillary carcinoma (follicular) |
6. | Benign | Iso | Microfollicular carcinoma |
7. | Not known | Iso | Papillary carcinoma |
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Prieditis, P.; Radzina, M.; Mikijanska, M.; Liepa, M.; Stepanovs, K.; Grani, G.; Durante, C.; Lamartina, L.; Trimboli, P.; Cantisani, V. Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison. Medicina 2022, 58, 257. https://doi.org/10.3390/medicina58020257
Prieditis P, Radzina M, Mikijanska M, Liepa M, Stepanovs K, Grani G, Durante C, Lamartina L, Trimboli P, Cantisani V. Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison. Medicina. 2022; 58(2):257. https://doi.org/10.3390/medicina58020257
Chicago/Turabian StylePrieditis, Peteris, Maija Radzina, Madara Mikijanska, Mara Liepa, Kaspars Stepanovs, Giorgio Grani, Cosimo Durante, Livia Lamartina, Pierpaolo Trimboli, and Vito Cantisani. 2022. "Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison" Medicina 58, no. 2: 257. https://doi.org/10.3390/medicina58020257