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Use of the thyroid imaging, reporting, and data system (TI‐RADS) scoring system for the evaluation of subcentimeter thyroid nodules
Author(s) -
Weiss Vivian L.,
Andreotti Rochelle F.,
Ely Kim A.
Publication year - 2018
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.22015
Subject(s) - medicine , thyroid nodules , nodule (geology) , radiology , atypia , biopsy , fine needle aspiration , thyroid , medical diagnosis , thyroid cancer , thyroid carcinoma , pathology , paleontology , biology
BACKGROUND The American Thyroid Association (ATA) recommends fine‐needle aspiration (FNA) biopsy of nodules measuring >1.5 cm with low‐suspicion sonographic patterns or >1.0 cm with high/intermediate‐suspicion features. Routine biopsy of nodules <1 cm is not recommended. However, despite these recommendations, subcentimeter nodules are often referred for FNA biopsy. METHODS This was a retrospective chart review of consecutive thyroid FNAs during an 18‐month period (1157 patients, 1491 nodules, 2016‐2017) to evaluate age, sex, medical history, diagnoses, and follow‐up. Radiographic information was used to identify 61 subcentimeter nodules (4%) from 57 patients. Ultrasound studies were re‐evaluated using criteria according to the American College of Radiology Thyroid Imaging, Reporting, and Data System (TI‐RADS). RESULTS Reported reasons for biopsy included a larger companion nodule (44%), a personal or family history of cancer (26%), or a suspicious sonogram, including calcification and/or irregular contours (16%). FNA diagnoses included: 69% benign (42 of 61 nodules), 10% papillary thyroid carcinoma (PTC) (6 of 61 nodules), and 15% atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (9 of 61 nodules). Seven percent of nodules were unsatisfactory/nondiagnostic (4 of 61 nodules) compared with a 3% nondiagnostic rate for all sized nodules. Fifty‐one nodules had an ultrasound available for re‐review using the TI‐RADS scoring system. A high TI‐RADS score (4‐5) was indicative of PTC in 29.4% of nodules. A low TI‐RADS score (1‐2) was indicative of PTC in 0% of nodules ( P < .01). High and intermediate TI‐RADS scores (3 and 4‐5, respectively) were indicative of PTC/AUS/FLUS in 32% of nodules compared with 0% in those with low TI‐RADS scores ( P < .01). CONCLUSIONS The current results demonstrate successful use of the TI‐RADS scoring system in evaluation of the risk of malignancy in subcentimeter nodules. Larger studies will be necessary to determine whether biopsy is warranted for TI‐RADS high‐subcentimeter nodules. Cancer Cytopathol 2018. © 2018 American Cancer Society.