Comparison of Different Ultrasound Classification Systems of Thyroid Nodules for Identifying Malignant Potential: A Cross-sectional Study

Chen, Hua; Ye, Jun; Song, Jianming; You, Yuguang; Chen, Weihua; Liu, Yanna

doi:10.6061/clinics/2021/e2126

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Clinics 76 • 2021 • https://doi.org/10.6061/clinics/2021/e2126 copy

Comparison of Different Ultrasound Classification Systems of Thyroid Nodules for Identifying Malignant Potential: A Cross-sectional Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

In our organization, it has been necessary in our organization to calculate the risk categories according to the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) classification systems for each patient, from the year 2019; these are also required to be registered in the database. This creates a barrier to medical collaboration in everyday radiological practice because using multiple rating systems can be confusing for both readers and patients. For the change in routine practice, this study aimed to compare diagnostic parameters of the ATA, AACE/ACE/AME, and ACR TIRADS classification systems for the detection of suspicious thyroid nodule(s) considering the results of fine-needle aspiration cytopathology as the reference standard.

METHODS:

Data on ultrasound characteristics (2,000 nodules) and fine-needle aspiration cytopathology (39 nodules) were included in the analysis. The decision making of fine-needle aspiration biopsies was evaluated from the ultrasound characteristics as per the ATA, AACE/ACE/AME, and ACR TIRADS classification systems.

RESULTS:

The ATA, AACE/ACE/AME, and ACR TIRADS recommended 26, 32, and 37 nodules for fine-needle aspiration biopsies, respectively. Considering the results of fine-needle aspiration cytopathology as the reference standard, the ATA, AACE/ACE/AME, and ACR TIRADS classification systems had 0.993, 0.996, and 0.998 sensitivity, respectively. The accuracies were 0.641, 0.795, and 0.923, respectively.

CONCLUSION:

The ACR TIRADS classification system is less invasive and can identify suspicious nodules more accurately than that of ATA and AACE/ACE/AME.

American Association of Clinical Endocrinologists; American College of Radiology Thyroid Imaging Reporting and Data System; American Thyroid Association; Thyroid Cancer; Ultrasound Examinations

Characteristics		Patients or value
Data of patients included in the analysis		2,000
Sex	Male	215 (11)
Sex	Female	1,785 (89)
Age (years)	Minimum	27
	Maximum	74
	Mean±SD	53.52±9.17
Body mass index (kg/m²)		24.91±1.95
Ethnicity	Han Chinese	1,839 (92)
	Mongolian	142 (7)
	Tibetan	19 (1)
Previous exposure to radiation		55 (3)
Personal history of thyroid cancer		84 (4)
Family history of thyroid cancer		107 (5)
Diabetes		295 (15)
Autoantibodies to thyroid peroxidase positive		612 (31)
Higher thyroid-stimulating hormone level (>2.5 mU/L)		589 (29)
Nodule size according to ultrasound finding (cm)	Minimum	0.61
	Maximum	6.12
	Mean±SD	2.55±0.85

Characteristics	Categorized nodules	Recommended for fine-needle aspiration biopsies	Comparisons between categorized nodules and nodules recommended for fine-needle aspiration biopsies
ATA
Data of nodules included in the analysis	2,000	26	p-value
Benign	22 (1)	0 (0)	<0.0001
Very low suspicion	42 (2)	2 (8)
Low suspicion	1,151 (58)	4 (15)
Intermediate suspicion	408 (20)	7 (27)
High suspicion	377 (19)	13 (50)
AACE/ACE/AME
Data of nodules included in the analysis	2,000	32	p-value
Low risk nodule	42 (2)	2 (6)	0.010
Medium risk nodule	994 (50)	8 (25)
High-risk nodule	964 (48)	22 (69)
ACR TIRADS
Data of nodules included in the analysis	2,000	37	p-value
TR 1	61 (3)	0 (0)	0.003
TR 2	142 (7)	2 (5)
TR 3	531 (27)	11 (30)
TR 4	918 (46)	9 (24)
TR 5	348 (17)	15 (41)

Ultrasound classification systems	Fleiss’ kappa coefficient (κ)
Numbers of readers	06
ATA	0.31
AACE/ACE/AME	0.37
ACR TIRADS	0.41

Characters	Fine-needle aspiration biopsies	ATA		AACE/ACE/AME		ACR TIRADS
Nodules included in analysis	39	2,000	^ Respect to the results of fine-needle aspiration biopsies. p-value	2,000	^ Respect to the results of fine-needle aspiration biopsies. p-value	2,000	^ Respect to the results of fine-needle aspiration biopsies. p-value
Nodules truly recommended for biopsy	39 (100)	25 (1.25)	<0.0001	31 (1.55)	<0.0001	36 (1.8)	<0.0001
Nodules truly not recommended for biopsy	0 (0)	1,961 (98.05)	<0.0001	1,961 (98.05)	<0.0001	1,961 (98.05)	<0.0001
Nodules falsely recommended for biopsy	0 (0)	1 (0.05)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.889	1 (0.05)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.889	1 (0.05)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.889
Nodules falsely not recommended for biopsy	0 (0)	13 (0.65)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.614	7 (0.35)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.711	2 (0.1)^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.843
Sensitivity	1	0.993^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.601	0.996^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.692	0.998^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.809
Accuracy	1	0.641	0.001	0.795	0.009	0.923^* * Insignificant difference with respect to the results of fine-needle aspiration biopsies.	0.239

Data of patients included in the analysis	39
Characteristics	Odd ratio	95% confidence limit	p-value
Sex (female^* * Significant parameter associated with suspicious nodules. vs. male)	1.212	0.658-0.954	0.021
Age (<45 years^* * Significant parameter associated with suspicious nodules. vs. ≥45 years)	1.113	0.721-0.913	0.042
Previous exposure of radiation (yes^* * Significant parameter associated with suspicious nodules. vs. no)	1.032	0.711-0.923	0.049
Personal history of thyroid cancer (yes^* * Significant parameter associated with suspicious nodules. vs. no)	1.045	0.722-0.941	0.048
Family history of thyroid cancer (yes vs. no)	0.989	0.756-0.895	0.052
Autoantibodies to thyroid peroxidase (positive vs. negative)	0.976	0.721-0.895	0.058
Thyroid-stimulating hormone level (>2.5 mU/L vs. ≤2.5 mU/L)	0.984	0.776-0.852	0.053
Nodule size according to ultrasound finding (<2 cm vs. ≥2 cm)	0.683	0.562-0.796	0.061

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail: jxnclyn0707@163.com