Clin Endocrinol (Oxf) 2014;81: (suppl 1): 1–22. Thus, a major finding of this study is that if thyroid nodules are strongly suspected of malignancy (ie, TI-RADS grade 5) on high-resolution ultrasound, the potential for malignancy of approximately 94% should be carefully considered even if the US-FNAC biopsy specimen indicates benign disease or cannot be evaluated; in fact, the accuracy of qualitative diagnosis for malignant thyroid nodules can be as high as 94% to 96%. Endocrine 2017;57:256–61. Value of US correlation of a thyroid nodule with initially benign cytologic results. Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. The measurement of observer agreement for cate-gorical data. Privacy, Help They are characterized as the local growth of abnormal thyroid cells that are significantly different from normal thyroid tissue surrounding the scattered mass. All subjects voluntarily provided written informed consent on each occasion of diagnostic examinations and therapeutic procedures and also for the publication of this study. Highlight selected keywords in the article text. However, US-FNAC is susceptible to specimen puncture bleeding, pathological cytological diagnosis errors, and relatively difficult nodular puncture, which could lead to substandard puncture specimen quality and difficulty in qualitative diagnosis. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Nondiagnostic or unsatisfactory (ND / UNS, < 10% of thyroid FNAs) Cyst fluid only (CFO) Virtually acellular specimen (need at least 6 groups of benign follicular cells, composed of at least 10 cells each for benign) Other (obscuring blood, clotting artifact, overly thick smear, etc.) 2017 Nov;27(11):1341-1346. doi: 10.1089/thy.2017.0500. The detection of these gene mutations in clinical practice has been found to improve the diagnosis rate. J Clin Endocrinol Metab 2015;100:4434–40. Visualization: Nong Li, Huiling Zhong, Jinquan Feng, Huajun Xu, Zhongxing Li. [32] Therefore, in the present study, we combined the high-resolution ultrasound TI-RADS grade and Bethesda classification grade in patients with thyroid nodules for a more comprehensive evaluation, and compared the outcomes with the pathology results after surgery. Please enable it to take advantage of the complete set of features! Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. Most of the patients undergoing surgery and US-FNAC included those with TI-RADS grades ≥4B (75.8% of all cases), and only a few cases (24.2% of all cases) had TI-RADS grades <4B (score ≤3). https://academic.oup.com/milmed/article-abstract/185/11-12/2020/5874038 [30]. [28]. For more information, please refer to our Privacy Policy. [email protected]. Kwong N, Medici M, Angell TE, et al. Lau RP, Paulsen JD, Brandler TC, Liu CZ, Simsir A, Zhou F. Am J Clin Pathol. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid fine-needle aspiration (FNA) specimens. Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category. The 2017 revision reaffirms that every thyroid FNA report should begin with one of six diagnostic categories, the names of which remain unchanged since they were first … Finally, only 2 medical centers were involved in the present study, and hence, future studies should prospectively include nonspecialized members from multiple centers, if possible. [31]. Durante C, Costante G, Lucisano G, et al. Diagnostic tests can be used to determine whether a thyroid nodule is benign or malignant (cancerous). [10]. Contents • Introduction • Bethesda categories – Nondiagnostic or Unsatisfactory – Benign – Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance – Follicular Neoplasm or Suspicious for a Follicular … [6]. The comprehensive scores with the TI-RADS classification and Bethesda classification in the diagnosis of thyroid cancer indicated that, of 327 thyroid nodules, 1 was of grade 2, 12 were of grade 3, 66 were of grade 4A, 71 were of grade 4B, 87 were of grade 4C, and 90 were of grade 5. Medicine. [30] However, such genetic testing needs to be performed in specialized medical testing institutions with special methods, which can be expensive[31] and difficult to implement, particularly for primary medical institutions. A larger area is associated with a higher accuracy. This bias is partially compensated by the sample size of the present study. [3]. Registered users can save articles, searches, and manage email alerts. Table 3 shows that, as the TI-RADS grading scores increased from 3 to 6 points, the sensitivity decreased, but its specificity increased. http://creativecommons.org/licenses/by-nc/4.0. According to our results, if the combination score ≥7, the false-positive rate is about 8.00%. Context: Fine needle aspiration (FNA) plays a crucial role in the evaluation of patients with thyroid lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was designed with a mission to standardize the process of diagnosis and management of thyroid lesions by FNA cytology (FNAC). First, conventional 2-dimensional ultrasound (gray scale) was performed to confirm the presence of the nodules, and for detailed observation by enlarging the nodules. An ultrasonogram reportin system for, [22]. Livhits MJ, Zhu CY, Kuo EJ, Nguyen DT, Kim J, Tseng CH, Leung AM, Rao J, Levin M, Douek ML, Beckett KR, Cheung DS, Gofnung YA, Smooke-Praw S, Yeh MW. 2015 American Thyroid Association Management Guidelines for adult patients with. [18]. [24]. [11]. [6,7], Thyroid nodules can be classified as benign or malignant. The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. . Sichuan University (e-mail: [email protected]). Mazzaferri EL. Due to the variety of US-FNAC performance of the thyroid nodules and the possibility of its false-negative results, current America Thyroid Association guidelines recommend ultrasonographic follow-up instead of direct surgery in patients with suspected benign thyroid nodules. Ultrasound is helpful to differentiate Bethesda class III. your express consent. studied the malignancy rates for nodules classified as Bethesda categories III and IV in a prospective study including 176 consecutive nodules. These diagnoses typically do not require surgical intervention. Thyroid cancer is the most common malignant tumor of the endocrine system, and accounts for 1.1% of all malignant tumors. Lippincott Journals Subscribers, use your username or email along with your password to log in. [20] A larger Kappa value is associated with a greater consistency of the judgment result. Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify reason) Negative for Intraepithelial Lesion or Malignancy. [27] Therefore, the combination of US-FNAC and high-resolution ultrasound could reduce the rate of missed diagnosis. Moreover, the TI-RADS grading scores and Bethesda classification scores were combined using an accumulative method to determine a comprehensive score (joint score: TI-RADS classification score + Bethesda classification score), and the ultrasound TI-RADS classification scores and thyroid fine-needle puncture Bethesda scores were compared with the postoperative pathological results. The present study has certain limitations. In Table 4, the TI-RADS 4 score, TI-RADS 5 score, Bethesda classification 3 score, and combined score of 7 under ROC curve had an area under the ROC curve of 0.817, 0.914, and 0.946, respectively (Table 4); the combined score of 7 indicated the largest area under the ROC curve (Fig. The incidence of thyroid cancer varies with geographical location, age, and sex. Moreover, Bethesda classification score 3 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 90.0%, 94.3%, and 91.1%, respectively, whereas the Kappa and ROC values were 0.78 and 0.914, respectively. Perros P, Boelaert K, Colley S, et al. The Authors. Conclusions: 800-638-3030 (within USA), 301-223-2300 (international)
The devices used for ultrasound examination were the ATL HDI 5000 (Absolute Medical Equipment, Wesley Hills, NY) and IU22 (Philips Healthcare, Andover, MA) ultrasound diagnostic instrument with a 5 to 12 MHz probe. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. The comprehensive scores with the TI-RADS classification and Bethesda classification in the diagnosis of thyroid cancer indicated that, of 327 thyroid nodules, 1 was of grade 2, 12 were of grade 3, 66 were of grade 4A, 71 were of grade 4B, 87 were of grade 4C, and 90 were of grade 5. [1] Most of the discovered nodules are benign, although an increase in the incidence of thyroid cancer has been reported. With regard to the pathological results of the 327 thyroid nodules, 235 malignant nodules were determined as papillary thyroid carcinoma, whereas the other 92 nodules were benign. for Reporting Thyroid Cytopathology (TBSRTC), introduced in 2009 and subsequently widely implemented Keywords: Risk of malignancy: 1 - 4%. Clinical observation data were collected in an Excel database, and were examined using the SPSS 17. Wang N, Zhou Y, Fu C, et al. Thus, TI-RADS4 had the highest accuracy (87.1%), TI-RADS4 and TI-RADS5 had the highest sensitivity + specificity (163.4%), and TI-RADS4 had the highest Kappa value (0.651). Please try again soon. The natural history of benign. Abstract. In 2009, Horvath et al[22] proposed a thyroid imaging reporting and data system (TI-RADS) based on the breast imaging reporting and data system of the American Society of Radiology (breast imaging reporting and data system; BI-RADS). Guidelines for the management of thyroid cancer. Pacini F, Vorontsova T, Demidchik EP, et al. Impact of the modification of the diagnostic criteria in the 2017 Bethesda System for Reporting Thyroid Cytopathology: a report of a single institution in Japan. [15,16] For nodules that cannot be diagnosed via ultrasound, ultrasound-guided thyroid fine-needle puncture cytology (US-FNAC) can be used for further diagnosis. Guth S, Theune U, Aberle J, et al. Receiver-operating curves of ultrasound in the evaluation of Bethesda class, [1]. The system led to standardization of FNA reports based Thus, the initial indication with FNAC can be used for better guidance and during follow-up. Moreover, the clinical application of TI-RADS is complicated, and different sonographers may have different classification results for the same image. Published by Wolters Kluwer Health, Inc. SUMMARY Background The Bethesda System for Reporting Thyroid Cyto-pathology (BSRTC) resulted from a conference held at the National Institutes of Health in 2007. 1). [4] The researchers found that the overall prevalence of thyroid nodules was 12.8%, whereas the prevalence of thyroid nodules in children aged 6 to 18 years was 10.59%, lower than that of Chinese adults. The patient was maintained in the supine position with a high neck pad and the thyroid fully exposed. The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated. [19]. High-resolution ultrasound is currently the preferred method to evaluate thyroid nodules. Writing – review & editing: Huiwen Tan, Nong Li. Thyroid nodules are commonly observed in the population (incidence: 4%–7%/10–18 million people), and may develop as a result of various thyroid disorders. [26]. Management of a solitary thyroid nodule. (C) Professor, Department of Pathology McGill University Director, Cytopathology Laboratory Higuchi M, Hirokawa M, Kanematsu R, Tanaka A, Suzuki A, Yamao N, Hayashi T, Kuma S, Miyauchi A. Endocr J. Data curation: Huiwen Tan, Zhihui Li, Jianrong Qian, Fengchun Fan, Huiling Zhong, Huajun Xu, Zhongxing Li. Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists. TI-RADS and Bethesda classification scores and the combination of the 2 comprehensive scores for the diagnosis of thyroid carcinoma in terms of sensitivity, specific, and accuracy. Epub 2012 Oct 18. Atypia of undetermined significance/follicular lesion of undetermined significance; Bethesda; Cytopathology; FNA; Fine-needle aspiration; Follicular neoplasm/suspicious for follicular neoplasm; Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); Papillary thyroid carcinoma; Risk of malignancy; Thyroid. Moreover, the comprehensive scores from the TI-RADS and Bethesda grading system in each patient, and the individual ultrasound TI-RADS and thyroid fine-needle puncture scores were compared with the criterion standard. Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)1 is … You may search for similar articles that contain these same keywords or you may
Different histologies and clinical scenarios make necessary a multidisciplinary approach that includes new diagnostic methods and surgical, radiopharmaceutical and systemic therapies. to maintaining your privacy and will not share your personal information without
High-resolution ultrasound TI-RADS grading and thyroid fine-needle puncture cytology grading (Bethesda classification), separately and in combination, were performed, and their accuracy, sensitivity, and specificity in the diagnosis of thyroid malignant nodules were compared. With regard to the Bethesda classification system, a score of 3 exhibited the highest Kappa value and accuracy (0.78 and 91.10%, respectively). Methodology: Huiwen Tan, Zhihui Li, Nong Li, Jianrong Qian, Fengchun Fan, Huiling Zhong, Jinquan Feng, Huajun Xu, Zhongxing Li. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. For permissions, please e-mail: journals.permissions@oup.com. JAMA Oncol. Park JY, Lee HJ, Jang HW, et al. Some error has occurred while processing your request. By continuing to use this website you are giving consent to cookies being used. Please enable scripts and reload this page.
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