ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology
ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology
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DOI：
10.1186/s12902-019-0429-5
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发表时间：
2019-10-29
影响因子：
2.7
通讯作者：
de Carvalho, Gisah Amaral
中科院分区：
文献类型：
--
作者：
Madsen Barbosa, Thayse Lozovoy;Mesa Junior, Cleo Otaviano;de Carvalho, Gisah Amaral
背景：细胞学上不确定的甲状腺结节目前是临床决策的一个挑战。我们研究的主要目的是确定分类，美国放射学会(ACR)TIRADS和2015年美国甲状腺协会(ATA)指南，结合贝塞斯达甲状腺细胞病理学报告系统(TBSRTC)，是否可以用于对不确定甲状腺结节的恶性风险进行分层，并指导其临床治疗。方法：机构审查委员会批准了这项回顾性研究，从2012年1月至2016年6月，139名患者的140个甲状腺结节接受了超声引导下细针吸取细胞学检查(FNAC)，细胞学结果不确定(Bethesda III级44例，Bethesda IV级52例，Bethesda V级44例)，并获得了FNAC前的甲状腺超声图像和手术后的组织学结果。每个包含的结节由一名放射科医生根据2015年ATA指南中推荐的ACR TIRADS评分和US分型对细胞学和组织学诊断盲法进行分类。根据Bethesda、TI-RADS评分、ATA US模式及其组合评估恶性肿瘤的风险。结果：140个不明原因甲状腺结节中，74个(52.9%)为组织学良性结节。在贝塞斯达III、IV和V之间观察到不同的恶性率(p<；0.001)。根据两种美国分类(TI-RADS和ATA)中的美国怀疑类别(P<；0.001)，恶性肿瘤的发生率增加。Bethesda III和US最低风险结节(ATA的极低、低和中等可疑，TI-RADS的2、3和4a)对两种分类的敏感性均为95.3%，阴性预测值分别为94.3%和94.1%。美国风险最高的类别(ATA的高度怀疑和TI-RADS的4b、4c和5)与癌症显著相关(优势比[OR]分别为14.7和9.8)。结论：超声分类、ACR TI-RADS和ATA指南可能有助于指导不确定甲状腺结节的治疗，建议对低风险美国怀疑结节和Bethesda III结节采取保守方法，而对高危美国怀疑结节和Bethesda IV或V型结节应考虑分子检测和手术。
Background: Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TIRADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods: The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results: Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions: Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.