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Exp Clin Endocrinol Diabetes 2024; 132(11): 596-606
DOI: 10.1055/a-2380-3674
Article

Evaluating the Diagnostic Role of ACR-TIRADS and Bethesda Classifications in Thyroid Nodules Highlighted by Cyto-Histopathological Studies

Marwa S. Eissa
1   Internal Medicine and Endocrinology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
2   Endocrinology Department, Faculty of Armed Forces of Medical College (AFMC), Cairo, Egypt
,
Rania M. Sabry
3   Anatomical Pathology, Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Mona S. Abdellateif
4   Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
› Author Affiliations Funding Information The manuscript had been funded by the Faculty of Medicine, Cairo University.
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Abstract

Objective To evaluate the accuracy of thyroid imaging reporting and data system (ACR-TIRADS) and the Bethesda system for reporting cytopathology (TBSRCP) classifications for identifying or ruling out thyroid malignancy in relation to the gold standard (post-surgical pathology).

Methods This cross-sectional study included 573 patients with single or multiple thyroid nodules. Patients were evaluated using the TIRADS and the TBSRCP classification. The data from a cohort of patients who underwent surgery (77/573, 13.4%) were correlated with post-operative pathology and the relevant clinical features of the patients.

Results Of 573 patients, 545 (95.1%) were euthyroid, 24 (4.1%) were hypothyroid, and 4 (0.8%) were hyperthyroid; 419 (73.1%) had benign nodules (Bethesda II), 115 (20.1%) had intermediate (Bethesda III, IV), and 39 (6.8%) had Bethesda V and VI nodules. Four-hundred twenty (73.3%) patients were categorized as TIRADS 2,3, and 153 (26.7%) were categorized as TIRADS 4,5. The Bethesda and TIRADS classifications concorded significantly in thyroid nodule diagnosis (K=14.9%, P<0.001).

Thyroid malignancy was significantly associated with microcalcification and interrupted halo, while benign nodules were significantly associated with macrocalcification and complete halo type (P=0.041, P=0.005, respectively).

The TBSRCP could significantly detect malignant thyroid nodules with a sensitivity, specificity, PPV, and NPV of 64.1%, 98.1%, 85.0%, and 94.1%, respectively (K=88.2%, P<0.001), while the respective values for the TIRADS classification were 63.5%, 76.0%, 84.6%, and 50.0% (K=34.8%, P=0.001).

Conclusion The TIRADS and TBSRCP are essential primary steps for evaluating thyroid nodules and both are complimentary. Hence, each patient with thyroid nodules should be evaluated by both approaches before opting for surgery. Highly suspicious TIRADS categories TR4 and TR5 need further evaluation by fine needle aspiration cytology.

Keywords

thyroid - TIRADS - FNAC - TBSRCP - diagnosis - ultrasonography


Publication History

Received: 18 November 2023
Received: 19 July 2024

Accepted: 05 August 2024

Accepted Manuscript online:
05 August 2024

Article published online:
30 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-249
    CrossrefPubMedSearch in Google Scholar
  • 3 Ancker OV, Kruger M, Wehland M. et al. Multikinase inhibitor treatment in thyroid cancer. Int J Mol Sci 2019; 21: 10
    CrossrefPubMedSearch in Google Scholar
  • 4 Li M, Dal Maso L, Vaccarella S. Global trends in thyroid cancer incidence and the impact of overdiagnosis. Lancet Diabetes Endocrinol 2020; 8: 468-470
    CrossrefPubMedSearch in Google Scholar
  • 5 Miranda-Filho A, Lortet-Tieulent J, Bray F. et al. Thyroid cancer incidence trends by histology in 25 countries: A population-based study. Lancet Diabetes Endocrinol 2021; 9: 225-234
    CrossrefPubMedSearch in Google Scholar
  • 6 Freedman LS, Edwards BK, Ries LAG. et al. Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel and Jordan) of the Middle East Cancer Consortium (MECC) Compared with US SEER. Pub. 2006. No 06-5873. Bethesda, MD: National Cancer Institute, NIH; 120-131
  • 7 Ibrahim AS, Khaled HM, Mikhail NN. et al. Cancer incidence in Egypt: Results of the national population-based cancer registry program. J Cancer Epidemiol 2014; 2014: 437971
    CrossrefPubMedSearch in Google Scholar
  • 8 Patel KN, Shaha AR. Poorly differentiated thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 121-126
    CrossrefPubMedSearch in Google Scholar
  • 9 Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol 2016; 2: 17
    CrossrefPubMedSearch in Google Scholar
  • 10 Mendes GF, Garcia MR, Falsarella PM. et al. Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: Accuracy of TIRADS classification system in more than 1000 nodules. Br J Radiol 2018; 91: 20170642
    CrossrefPubMedSearch in Google Scholar
  • 11 Tessler FN, Middleton WD, Grant EG. et al. ACR Thyroid imaging, reporting and data system (TI-RADS): White paper of the ACR TI-RADS committee. J Am Coll Radiol 2017; 14: 587-595
    CrossrefPubMedSearch in Google Scholar
  • 12 Horvath E, Silva CF, Majlis S. et al. Prospective validation of the ultrasound based TIRADS (thyroid imaging reporting and data system) classification: Results in surgically resected thyroid nodules. Eur Radiol 2017; 27: 2619-2628
    CrossrefPubMedSearch in Google Scholar
  • 13 Espinosa De Ycaza AE, Lowe KM, Dean DS. et al. Risk of malignancy in thyroid nodules with non-diagnostic fine-needle aspiration: A retrospective cohort Study. Thyroid 2016; 26: 1598-1604
    CrossrefPubMedSearch in Google Scholar
  • 14 Abolhasani Foroughi A, Mokhtari M, Heidari E. et al. Concordance between TIRADS and cytology in thyroid nodule. Iran J Otorhinolaryngol 2022; 34: 295-302
    CrossrefPubMedSearch in Google Scholar
  • 15 Grimm D. Recent advances in thyroid cancer research. Int J Mol Sci 2022; 23: 4631
    CrossrefPubMedSearch in Google Scholar
  • 16 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26: 1-133
    CrossrefPubMedSearch in Google Scholar
  • 17 Xie M, Gupta MK, Archibald SD. et al. The usefulness of the thyroid imaging reporting and data system in determining thyroid malignancy. Laryngoscope 2020; 130: 2087-2091
    CrossrefPubMedSearch in Google Scholar
  • 18 Crockett JC. The thyroid nodule: Fine-needle aspiration biopsy technique. J Ultrasound Med 2011; 30: 685-694
    CrossrefPubMedSearch in Google Scholar
  • 19 Anand B, Ramdas A, Ambroise MM. et al. The Bethesda system for reporting thyroid cytopathology: A cytohistological study. J Thyroid Res 2020; 2020: 8095378
    CrossrefPubMedSearch in Google Scholar
  • 20 Mathew IE, Mathew A. Rising thyroid cancer incidence in Southern India: An epidemic of overdiagnosis?. J Endocr Soc 2017; 1: 480-487
    CrossrefPubMedSearch in Google Scholar
  • 21 Gao L, Xi X, Jiang Y. et al. Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules. Endocrine 2019; 64: 90-96
    CrossrefPubMedSearch in Google Scholar
  • 22 Kobaly K, Kim CS, Langer JE. et al. Macrocalcifications do not alter malignancy risk within the American Thyroid Association sonographic pattern system when present in non-high suspicion thyroid nodules. Thyroid 2021; 31: 1542-1548
    CrossrefPubMedSearch in Google Scholar
  • 23 Sakthisankari S, Vidhyalakshmi S, Shanthakumari S. et al. The combination of ACR-Thyroid Imaging Reporting and Data system and the Bethesda System for reporting thyroid cytopathology in the evaluation of thyroid nodules-an institutional experience. Cytopathology 2021; 32: 472-481
    CrossrefPubMedSearch in Google Scholar
  • 24 Theoharis CG, Schofield KM, Hammers L. et al. The Bethesda thyroid fine-needle aspiration classification system: Year 1 at an academic institution. Thyroid 2009; 19: 1215-1223
    CrossrefPubMedSearch in Google Scholar
  • 25 Bohacek L, Milas M, Mitchell J. et al. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2012; 19: 45-51
    CrossrefPubMedSearch in Google Scholar
  • 26 Singaporewalla RM, Hwee J, Lang TU. et al. Clinico-pathological correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World J Surg 2017; 41: 1807-1811
    CrossrefPubMedSearch in Google Scholar
  • 27 Middleton WD, Teefey SA, Reading CC. et al. Multiinstitutional analysis of thyroid nodule risk stratification using the American College of Radiology Thyroid Imaging Reporting and Data System. AJR AM J Roentgenol 2017; 208: 1331-1341
    CrossrefPubMedSearch in Google Scholar
  • 28 Chatti HA, Oueslati I, Azaiez A. et al. Diagnostic performance of the EU TI-RADS and ACR TI-RADS scoring systems in predicting thyroid malignancy. Endocrinol Diabetes Metab 2023; 6: e434
    CrossrefPubMedSearch in Google Scholar
  • 29 Merhav G, Zolotov S, Mahagneh A. et al. Validation of TIRADS ACR risk assessment of thyroid nodules in comparison to the ATA guidelines. J Clin Imaging Sci 2021; 11: 37
    CrossrefPubMedSearch in Google Scholar
  • 30 Ho AS, Sarti EE, Jain KS. et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid 2014; 24: 832-839
    CrossrefPubMedSearch in Google Scholar
  • 31 Turkdogan S, Pusztaszeri M, Forest VI. et al. Are Bethesda III thyroid nodules more aggressive than Bethesda IV thyroid nodules when found to be malignant?. Cancers 2020; 12: 2563
    CrossrefPubMedSearch in Google Scholar
  • 32 Foroughi AA, Mokhtari M, Heidari E. et al. Concordance between TIRADS and cytology in thyroid nodule. Iran J Otorhinolaryngol 2022; 34: 295-302
    CrossrefPubMedSearch in Google Scholar
  • 33 Livani S, Naeimi E, Taghavi N. Agreement between thyroid nodules ultrasound and cytology of fine needle aspiration (FNA) based on TIRADS and Bethesda system. J Gorgan Univ Med Sci 2020; 22: 106-112
    PubMedSearch in Google Scholar
  • 34 Periakaruppan G, Seshadri KG, Vignesh Krishna GM. et al. Correlation between ultrasound-based TIRADS and Bethesda system for reporting thyroid-cytopathology: 2-year experience at a tertiary care center in India. Indian J Endocrinol Metab 2018; 22: 651-655
    CrossrefPubMedSearch in Google Scholar
  • 35 Vargas-Uricoechea H, Meza-Cabrera I, HerreraChaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid Res 2017; 10: 1
    CrossrefPubMedSearch in Google Scholar