Follow-Up or Surgery for Indeterminate Thyroid Nodules: Could the CUT Score Application Be a Support for Decision-Making in the Preoperative Assessment?

The CUT score is a thyroid nodule scoring system that has become recently available as a smartphone application. It has been created on the basis of a clinical (C) and ultrasonographic (U) meta-analysis of suspicious thyroid nodule features to help clinicians with the preoperative malignancy risk assessment of thyroid nodules. The aim of the present study was to analyze the C + U sum of the CUT score for cytologically indeterminate TIR3A and TIR3B thyroid nodules, comparing the results obtained from the two groups. The CUT score was applied to 201 cytologically indeterminate thyroid nodules, 78 categorized as TIR3A and 123 as TIR3B. The Mann-Whitney test was applied to compare the C + U score values of the two groups, and a receiver operating characteristic (ROC) curve analysis was performed to validate the C + U score as a diagnostic test. In both groups, the median C + U value of all nodules was significantly higher in case of malignant (4.37 TIR3A, 4.50 TIR3B) versus benign nodules (2.75 TIR3A, 3.00 TIR3B). Through ROC curve analysis within the TIR3A group, a C + U value ≥4.00 was determined as diagnostic cutoff for the detection of malignant nodules (56% sensitivity, 77% specificity, area under the curve [AUC] = 0.714); and for the TIR3B group, a cutoff of C + U value of ≥3.75 was identified (65% sensitivity, 78% specificity, AUC = 0.744). The CUT score could represent a valid aid for the clinician in the management of indeterminate nodules with follicular proliferation.