Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Pathology Division, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Eur J Radiol. 2022 May;150:110244. doi: 10.1016/j.ejrad.2022.110244. Epub 2022 Mar 10.
The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a risk stratification system for thyroid nodules based on their ultrasonography (US) characteristics. Here, we aimed to assess TI-RADS on fine needle aspiration biopsy (FNAB) recommendations and performance in thyroid nodules.
We performed a retrospective study in a single center. All patients with thyroid nodules who underwent FNAB between 2012 and 2019 were included. TI-RADS data were extracted from medical records. Malignancy rates were defined based on cytological exams.
A total of 1,044 nodules (938 patients) were evaluated. TI-RADS classification was as follows: 13 TI-RADS 1, 524 TI-RADS 2, 273 TI-RADS 3, 148 TI-RADS 4, and 85 TI-RADS 5. TI-RADS classification showed a sensitivity of 75% (95 %CI: 63-84.7), a negative predictive value of 97.6% (95 %CI: 96.5-98.5), and accuracy of 73.1% (95 %CI: 70.3-75.8). According to TI-RADS FNAB criteria, only 314 (30%) nodules would have undergone FNAB. Of them, 157 (50%) were classified as benign (Bethesda II), 45 (14.3%) as undetermined (Bethesda III or IV), and 51 (16.2%) as malignant (Bethesda V or VI). Of the remaining 729 nodules that did not meet FNAB criteria, 17 (2.3%) had Bethesda V or VI and underwent surgery. Of them, four (23%) were <1 cm in size (microcarcinomas), and eight (47.0%) remain in follow-up according to the TI-RADS criteria. Seven malignant cases would be missed (0.9%).
ACR TI-RADS allows a significant decrease in the number of FNAB, increasing its diagnostic accuracy.
美国放射学院甲状腺影像报告和数据系统（ACR TI-RADS）是一种基于超声（US）特征的甲状腺结节风险分层系统。在此，我们旨在评估甲状腺细针抽吸活检（FNAB）推荐和 TI-RADS 在甲状腺结节中的表现。
我们在一家单中心进行了一项回顾性研究。所有于 2012 年至 2019 年间接受 FNAB 的甲状腺结节患者均纳入研究。从病历中提取 TI-RADS 数据。恶性肿瘤发生率基于细胞学检查确定。
共评估了 1044 个结节（938 例患者）。TI-RADS 分类如下：13 个 TI-RADS 1 级，524 个 TI-RADS 2 级，273 个 TI-RADS 3 级，148 个 TI-RADS 4 级，85 个 TI-RADS 5 级。TI-RADS 分类的敏感性为 75%（95%CI：63-84.7），阴性预测值为 97.6%（95%CI：96.5-98.5），准确性为 73.1%（95%CI：70.3-75.8）。根据 TI-RADS FNAB 标准，仅 314 个（30%）结节将接受 FNAB。其中，157 个（50%）为良性（Bethesda II 级），45 个（14.3%）为不确定（Bethesda III 或 IV 级），51 个（16.2%）为恶性（Bethesda V 或 VI 级）。其余 729 个不符合 FNAB 标准的结节中，有 17 个（2.3%）为 Bethesda V 或 VI 级并接受了手术。其中，4 个（23%）结节<1cm 大小（微癌），8 个（47.0%）根据 TI-RADS 标准仍在随访中。将漏诊 7 例恶性病例（0.9%）。
ACR TI-RADS 可显著减少 FNAB 数量，提高诊断准确性。
