Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.
Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia.
Medicina (Kaunas). 2022 Feb 9;58(2):257. doi: 10.3390/medicina58020257.
: The aim of the study was to evaluate the predictive value of the ultrasound criterion "non-marked hypoechogenicity" for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M-TIRADS score. : A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound-guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M-TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller-than-wide shape, metastatic lymph nodes). Non-marked hypoechoic nodules were classified as TIRADS 3. : Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub-cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M-TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR-18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M-TIRADS and Kwak systems-0.9 vs. 0.8, respectively). Accuracy of M-TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. : The non-marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M-TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.
: 本研究旨在评估超声标准“无标记低回声性”对恶性肿瘤的预测价值，并确定将这些结节分类为 TIRADS 3 是否可以提高随后调整的 M-TIRADS 评分的整体准确性。 : 共有 767 名患者的 795 个甲状腺结节接受了超声检查和超声引导下细针抽吸活检。根据可疑超声特征的数量（标记性低回声、微叶状或不规则边缘、微钙化、高宽比、转移性淋巴结），将结节分为 Kwak TIRADS 和改良（M-TIRADS）类别 4A、4B 和 5。无标记低回声性结节被分类为 TIRADS 3。 : 甲状腺结节的 TIRADS 分类分别为 2、3、4A、4B 和 5 的比例为 14.5%、57.5%、14.2%、8.1%和 5.7%。只有组织病理学结果（125 个结节接受了手术）和高特异性细胞学结果（Bethesda II、VI）被接受为参考标准，形成了 562/795 个结节的亚组（70.7%）。恶性肿瘤的发现率为 7.7%。总的来说，M-TIRADS 的敏感性/特异性为 93.02%/81.31%，而对于阳性预测值/阴性预测值，分别为 29.2%/99.29%（OR-18.62）。不规则边缘的敏感性和特异性最高（分别为 75.68%和 93.74%）。在 TIRADS 3 类别中，37.2%的结节为等回声，6.6%为高回声，52.2%为低回声（M-TIRADS 和 Kwak 系统之间低回声结节的恶性风险无差异-0.9 与 0.8）。在该队列中，M-TIRADS 分类的准确性为 78.26%，而 Kwak 为 48.11%。 : 无标记低回声结节模式与恶性肿瘤的低风险相关；将这些结节分类为 TIRADS 3 可显著提高预测价值和整体准确性，将 TIRADS 4 类的恶性肿瘤风险增加 20%；而 TIRADS 3 中恶性肿瘤风险无显著变化可能有助于减少过度诊断，避免需要进行 FNA。
