It consists of a 6-point scale for risk stratification with increasing risks of malignancy. This is a system similar to the one used for breast imaging. in 2009, known as the Thyroid Imaging Reporting and Data System (TIRADS). Based on the “classic pattern” concept, a tool for US classification of thyroid nodules was developed by Horvath et al. This has prompted the development of standardized systems for reporting US features, in an attempt to delineate sets of characteristics associated with specific risk levels for malignancy. reported similar findings, as the highest risk of malignancy was associated with a “taller-than-wide” shape (DOR of 10.2 95% CI: 6.7–15.3), an absent halo sign (7.1 95% CI: 3.7–13.7), microcalcifications (6.8 95% CI: 4.7–9.7), and irregular margins (6.1 95% CI: 3.1–12.0).Įxisting Guidelines and US Scoring SystemsĪs no single US feature can reliably predict malignancy, the approach should be to combine several features (“classic pattern” recognition) to enhance the diagnostic value of US. found the highest specificities for absence of elasticity, microcalcifications, irregular margins, and a “taller-than-wide” shape (86.2, 87.8, 83.1, and 96.6%, respectively). In unselected nodules, all features were significantly associated with malignancy, showing DORs in the ranges of 1.8–35.7 and 1.2–10.2. Two more meta-analyses included 52 and 41 observational studies and a total of 12,786 and 29,678 nodules, respectively. Experienced physicians performed better in the interpretation of internal calcifications than did less experienced colleagues (DOR of 14.5 vs. The features with the highest diagnostic odds ratio (DOR) for predicting malignancy were a “taller-than-wide” shape (11.1 95% CI: 6.6–18.9) and internal calcifications (6.8 95% CI: 4.5–10.2), while a spongiform (12 95% CI: 0.6–234.3) and a cystic appearance (6.8 95% CI: 2.3–20.3) most reliably predicted benignity. included 31 studies and a total of 18,288 nodules, of which 20% were thyroid cancer. Looking at recent meta-analyses of US accuracy in the prediction of thyroid cancer, Brito et al. Furthermore, there is substantial interobserver variation in the assessment and reporting of some of the US patterns. These criteria have various sensitivity and specificity, but unfortunately none of them alone is sufficient to discard or detect malignancy efficiently. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.Ĭertain features of thyroid nodules on ultrasound (US) are consistently predictive of malignancy and are used as criteria for FNA. This comprises a thyroid US lexicon a standardized report definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category and indications for FNA. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. The main disadvantage of the method is that it is operator dependent. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. Thyroid ultrasound (US) is a key examination for the management of thyroid nodules.
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