Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
Pathology Unit, City of Health and Science University Hospital, Turin, Italy.
Endocrine. 2021 May;72(2):486-494. doi: 10.1007/s12020-020-02495-y. Epub 2020 Oct 2.
Several ultrasound (US) risk stratification systems (US-RSSs) have been proposed to stratify the risk of malignancy (ROM) of thyroid nodules. This risk might be overestimated due to selection bias and comparison with the cytological report alone. Our study aimed to compare ROM and diagnostic performance of three guidelines (ATA, AACE/ACE/AME, EUTIRADS) and evaluate the changes in unnecessary biopsy according to the nodule size cutoff for biopsy, using histology as gold standard.
This retrospective observational study included 146 consecutive patients who underwent surgery after US and cytological characterization. We analyzed the effectiveness and accuracy of three US-RSSs.
46.6% of nodules were diagnosed as malignant. Applying US-RSS, the percentage of nodules that should have been analyzed by biopsy was 84.25% with ATA, 69.86% with EUTIRADS and 64.38% with AACE/ACE/AME systems. The ROM was 94.9%, 86.0%, 87.0% for high-risk category, 36.4%, 32.0%, 35.4% for intermediate-risk category and 22.9%, 0.0%, 22.9% for low-risk category by ATA, AACE/ACE/AME and EUTIRADS systems, respectively. EUTIRADS and AACE/ACE/AME systems were more accurate in differentiating malignant from benign cases. ATA score was the more sensitive US-RSS to identify malignant tumors within the high-risk category. About the unnecessary biopsies, in the intermediate-risk category, the application of the size criterion helps to increase specificity in all systems.
The US categorization of low and high-risk thyroid nodules using current US-RSSs helps alone to determine the optimal treatment option. Nodule size remains relevant to recommend biopsy for the intermediate-risk category.
已经提出了几种超声（US）风险分层系统（US-RSS）来分层甲状腺结节的恶性肿瘤风险（ROM）。由于选择偏倚和仅与细胞学报告比较，这种风险可能被高估。我们的研究旨在比较三种指南（ATA、AACE/ACE/AME、EUTIRADS）的 ROM 和诊断性能，并根据活检大小的截止值评估不必要活检的变化，以组织学为金标准。
这项回顾性观察性研究包括 146 例连续接受 US 和细胞学特征检查后手术的患者。我们分析了三种 US-RSS 的有效性和准确性。
46.6%的结节被诊断为恶性。应用 US-RSS，ATA 应分析活检的结节比例为 84.25%，EUTIRADS 为 69.86%，AACE/ACE/AME 系统为 64.38%。高危组的 ROM 为 94.9%、86.0%、87.0%，中危组为 36.4%、32.0%、35.4%，低危组为 22.9%、0.0%、22.9%ATA、AACE/ACE/AME 和 EUTIRADS 系统分别为。EUTIRADS 和 AACE/ACE/AME 系统在区分良恶性病例方面更为准确。ATA 评分是识别高危组恶性肿瘤更敏感的 US-RSS。关于不必要的活检，在中危组中，应用大小标准有助于提高所有系统的特异性。
使用当前的 US-RSS 对低危和高危甲状腺结节进行 US 分类有助于单独确定最佳治疗方案。结节大小仍然与推荐中间风险类别的活检有关。
