Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

<b>Objective:</b> The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and teste...

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Autores principales:	Davide Seminati, Giulia Capitoli, Davide Leni, Davide Fior, Francesco Vacirca, Camillo Di Bella, Stefania Galimberti, Vincenzo L’Imperio, Fabio Pagni
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	ultrasound imaging thyroid nodule thyroid carcinoma fine-needle aspiration Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/6515e57de9654ef1a1390ea75b1a97eb
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spelling	oai:doaj.org-article:6515e57de9654ef1a1390ea75b1a97eb2021-11-11T15:31:55ZUse of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage10.3390/cancers132154392072-6694https://doaj.org/article/6515e57de9654ef1a1390ea75b1a97eb2021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5439https://doaj.org/toc/2072-6694<b>Objective:</b> The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. <b>Design and Methods:</b> The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. <b>Results:</b> FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, <i>p</i> = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, <i>p</i> < 0.0001) and positive predictive values (77.5% vs. 50.7%, <i>p</i> < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. <b>Conclusions:</b> The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.Davide SeminatiGiulia CapitoliDavide LeniDavide FiorFrancesco VacircaCamillo Di BellaStefania GalimbertiVincenzo L’ImperioFabio PagniMDPI AGarticleultrasound imagingthyroid nodulethyroid carcinomafine-needle aspirationNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5439, p 5439 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ultrasound imaging thyroid nodule thyroid carcinoma fine-needle aspiration Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	ultrasound imaging thyroid nodule thyroid carcinoma fine-needle aspiration Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Davide Seminati Giulia Capitoli Davide Leni Davide Fior Francesco Vacirca Camillo Di Bella Stefania Galimberti Vincenzo L’Imperio Fabio Pagni Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
description	<b>Objective:</b> The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. <b>Design and Methods:</b> The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. <b>Results:</b> FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, <i>p</i> = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, <i>p</i> < 0.0001) and positive predictive values (77.5% vs. 50.7%, <i>p</i> < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. <b>Conclusions:</b> The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.
format	article
author	Davide Seminati Giulia Capitoli Davide Leni Davide Fior Francesco Vacirca Camillo Di Bella Stefania Galimberti Vincenzo L’Imperio Fabio Pagni
author_facet	Davide Seminati Giulia Capitoli Davide Leni Davide Fior Francesco Vacirca Camillo Di Bella Stefania Galimberti Vincenzo L’Imperio Fabio Pagni
author_sort	Davide Seminati
title	Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
title_short	Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
title_full	Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
title_fullStr	Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
title_full_unstemmed	Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage
title_sort	use of diagnostic criteria from acr and eu-tirads systems to improve the performance of cytology in thyroid nodule triage
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6515e57de9654ef1a1390ea75b1a97eb
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Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

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