From the University of California, Davis Medical Center, Sacramento, California.
From the University of California, Davis Medical Center, Sacramento, California..
Endocr Pract. 2020 Sep;26(9):945-952. doi: 10.4158/EP-2020-0024.
Management of thyroid nodules with Bethesda category III and IV cytology on fine needle aspiration (FNA) is challenging as they cannot be adequately classified as benign or malignant. Ultrasound (US) patterns have demonstrated the utility in evaluating the risk of malignancy (ROM) of Bethesda category III nodules. This study aims to evaluate the value of 3 well-established US grading systems (American Thyroid Association [ATA], Korean Thyroid Imaging Reporting and Data System [Korean-TIRADS], and The American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS]) in determining ROM in Bethesda category IV nodules.
Ninety-two patients with 92 surgically resected thyroid nodules who had Bethesda category IV cytology on FNA were identified. Nodule images were retrospectively graded using the 3 systems in a blinded manner. Associations between US risk category and malignant pathology for each system were analyzed.
Of the 92 nodules, 56 (61%) were benign and 36 (39%) were malignant. Forty-seven per cent of ATA high risk nodules, 53% of K-TIRADS category 5 nodules, and 50% of ACR-TIRADS category 5 nodules were malignant. The ATA high-risk category had 25% sensitivity, 82% specificity, 47% positive predictive value (PPV) for malignancy. K-TIRADS category 5 had 25% sensitivity, 85% specificity, 53% PPV for malignancy. ACR-TIRADS category 5 had 25% sensitivity, 84% specificity, 50% PPV for malignancy. None of the 3 grading systems yielded a statistically significant correlation between US risk category and the ROM (P = .30, .72, .28).
The ATA, Korean-TIRADS, and ACR-TIRADS classification systems are not helpful in stratifying ROM in patients with Bethesda category IV nodules. Clinicians should be cautious of using ultra-sound alone when deciding between therapeutic options for patients with Bethesda category IV thyroid nodules.
对于细针穿刺（FNA）检查提示 Bethesda 分类为 3 类和 4 类的甲状腺结节，其管理颇具挑战，因为这些结节无法被明确归类为良性或恶性。超声（US）模式已被证明可用于评估 Bethesda 分类为 3 类结节的恶性风险（ROM）。本研究旨在评估 3 种成熟的 US 分级系统（美国甲状腺协会 [ATA]、韩国甲状腺影像报告和数据系统 [Korean-TIRADS] 和美国放射学院甲状腺影像报告和数据系统 [ACR-TIRADS]）在确定 Bethesda 分类为 4 类结节的 ROM 方面的价值。
共纳入 92 例 FNA 检查提示 Bethesda 分类为 4 类的甲状腺结节患者，共 92 例。以盲法方式使用这 3 种系统对结节图像进行回顾性分级。分析了每种系统的 US 风险类别与恶性病理之间的关系。
在这 92 个结节中，56 个（61%）为良性，36 个（39%）为恶性。ATA 高危结节中 47%、K-TIRADS 5 类结节中 53%、ACR-TIRADS 5 类结节中 50%为恶性。ATA 高危类别对恶性病变的敏感性为 25%，特异性为 82%，阳性预测值（PPV）为 47%。K-TIRADS 5 类对恶性病变的敏感性为 25%，特异性为 85%，PPV 为 53%。ACR-TIRADS 5 类对恶性病变的敏感性为 25%，特异性为 84%，PPV 为 50%。这 3 种分级系统均未能显示出 US 风险类别与 ROM 之间存在统计学显著相关性（P =.30、.72、.28）。
ATA、Korean-TIRADS 和 ACR-TIRADS 分类系统无助于分层 Bethesda 分类为 4 类结节的 ROM。对于 Bethesda 分类为 4 类甲状腺结节的患者，在决定治疗方案时，临床医生应谨慎使用超声。
