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Ultraschall Med 2021; 42(04): 388-394
DOI: 10.1055/a-1033-1351
Original Article

A Simplified Ultrasonographic Score for the Prediction of Cytologically Suspicious Thyroid Nodules

Vereinfachter Ultraschall-Score zur Vorhersage von zytologisch suspekten Schilddrüsenknoten
Loredana Pagano
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Alessandro Bisceglia
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Fabrizio Riganti
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Sara Garberoglio
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Ruth Rossetto
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Nadia Bonelli
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Laura Viberti
2   Candiolo Cancer Institute – FPO, IRCCS, Str. Prov. 142, km 3.95, I-10060, Candiolo (To), Italy
,
Donatella Pacchioni
3   Pathology Unit, City of Health and Science University Hospital, Turin, Italy
,
Mauro Papotti
4   Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
,
Ezio Ghigo
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Mauro Maccario
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
,
Roberto Garberoglio
1   Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
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Correction: A Simplified Ultrasonographic Score for the Prediction of Cytologically Suspicious Thyroid NodulesUltraschall Med 2021; 42(04): e57-e57
DOI: 10.1055/a-1213-0391

Abstract

Purpose The major aim of ultrasound (US)-based risk stratification systems is to reduce unnecessary thyroid biopsies without losing the ability to recognize nodules with clinically significant malignancy. Each of the classic suspicious features of a thyroid nodule detected on US scan (hypoechoic pattern, microcalcifications, irregular margin, taller than wide shape, irregular vascularization) is significantly independently associated with the probability of malignancy, but none of them has good diagnostic accuracy. Thus, we evaluated the predictive value of a binary score simply based on the combination of these US features, regardless of the specific predictive value of each US feature, against the outcome of suspected malignancy at cytological diagnosis (TIR3 to TIR5 categories by SIAPEC-IAP [TIR+]).

Materials and Methods 1009 thyroid nodules from 1081 patients were considered. The US features of suspicion of all nodules were categorized in 5 binary scores (U1 to U5), each including from 1 to 5 of those features.

Results U2 (at least 2 US suspicious features) was the most balanced predictor of TIR+ (PPV 0.48, NPV 0.93, LR+ 3.05 and LR– 0.24). Weighting the predictivity of the single features did not improve the estimate. Using U2 as the criterion to send nodules to FNAC would have reduced the number of biopsies by 60 % (604 patients) and the false negatives would have only accounted for 41 cases out of 237 TIR+ (17 %) with 39 cases of TIR3 and 2 cases of TIR4, including only 6 malignant nodules on histological examination. U2 performed much better than the ATA recommendations for detecting those nodules, resulting in TIR+ at cytology.

Conclusion This simple and reproducible sonographic score based on 2 US features of suspicion of malignancy has quite a good performance with respect to identifying thyroid lesions categorized by cytology as medium-high risk of malignancy and could allow us to reduce cytology costs for low-risk nodules.

Zusammenfassung

Ziel Das Hauptziel von Systemen zur Risikostratifizierung mittels Ultraschalls (US) ist die Reduktion unnötiger Schilddrüsenbiopsien ohne jedoch den Verlust der Fähigkeit, Knoten mit klinisch bedeutsamer Malignität zu erkennen. Jedes der klassischen verdächtigen sonografischen Kriterien eines Schilddrüsenknotens (hypoechogene Struktur, Mikrokalzifizierungen, irregulärer Randsaum, Tiefer-als-breit Form, unregelmäßige Vaskularisierung) ist signifikant unabhängig mit der Wahrscheinlichkeit einer Malignität assoziiert, aber keines davon hat eine gute diagnostische Genauigkeit. Deshalb haben wir den Vorhersagewert eines binären Scores, der auf der Kombination dieser US-Kriterien basiert, unabhängig vom spezifischen Vorhersagewert jedes einzelnen US-Kriteriums bewertet in Bezug auf die Ergebnisse der vermuteten Malignität in der Zytologie (Kategorien TIR3 bis TIR5 der SIAPEC-IAP (TIR+)).

Material und Methoden 1009 Schilddrüsenknoten von 1081 Patienten wurden eingeschlossen. Die US-Kriterien für den Verdacht aller Knoten wurden in 5 binäre Scores (U1 bis U5) unterteilt, die jeweils 1 bis 5 dieser Kriterien beinhalten.

Ergebnisse U2 (mindestens 2 verdächtige US-Kriterien) war der ausgewogenste Prädiktor für TIR+ (PVW 0,48, NVW 0,93, LR+ 3,05 und LR– 0,24). Die Gewichtung des Vorhersagewerts der einzelnen Kriterien hat die Abschätzung nicht verbessert. Mit U2 als Kriterium für die Weiterleitung der Knoten an die FNAC würde die Anzahl der Biopsien um 60 % reduziert (604 Patienten) werden und die falsch negativen hätten nur 41 von 237 TIR+-Fällen (17 %) ausgemacht, davon 39 Fälle mit TIR3 und 2 Fälle mit TIR4, einschließlich von lediglich 6 malignen Knoten in der Histologie. Für den Nachweis dieser Knoten erwies sich U2 besser als die ATA-Empfehlungen und ergab TIR+ in der Zytologie.

Schlussfolgerung Dieser einfache und reproduzierbare sonografische Score, der auf 2 US-Kriterien für den Verdacht auf Malignität basiert, hat eine recht gute diagnostische Leistung bei der Identifizierung von Schilddrüsenläsionen, die in der Zytologie als mittelhohes Malignitätsrisiko eingestuft werden, gezeigt und könnte eine Kostensenkung in der Zytologie für risikoarme Knoten erlauben.

Key words

thyroid - ultrasound - simplified - cytological - score


Publication History

Received: 14 April 2019

Accepted: 10 October 2019

Article published online:
03 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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