Diagnostic value of ultrasound in the evaluation of the echostructures of the nodular formation of the thyroid gland using the classification system TI-RADS
Objective. Estimation of the ultrasonographic criteria efficacy in accordance to the TI-RADS system while determining the morphological structures of nodal thyroid affections.
Materials and methods. Results of ultrasonographic investigation in 546 patients, ageing 17 - 76 old and suffering thyroidal nodal affections, were analyzed.
All the patients were divided into two groups. Into the firsr group (the main) 427 (78.2%) patients were included, to whom ultrasonographic investigation was performed by a surgeon-endocrinologist. Into the second group (the control one) 119 (21.8%) patients were included, to whom ultrasonographic investigation was performed by a radiologist. Ultrasonographic criteria with nodal thyroidal affections were estimated in accordance to the TI-RADS scale, and the results of cytological investigations of the nodal affections - in accordance to criteria of the Bethesda system. The degree of the malignant nodal affections risk was determined, taking into account a quantity of intranodal echographic signs in accordance to the points gradation, using a Ti-RADS system.
Results. In accordance to results of pathohistological investigations of the removed specimen a benign changes were revealed in 128 (76.6%) patients, and malignant - in 39 (23.4%). In structure of malignant affections papillary cancer was established in 23 patients, follicular - in 13, medullary - in 2, Hurtle-cellular - in 1 patient. In accordance to cytological investigations, conducted in 2014 - 2018 yrs., there was established, that in the first group a fine-needle biopsy was conducted in 211/427(49.4%) patients. Operative interventions were performed in 105 (24.6%) patients. In the second group a fine-needle biopsy was performed in 64/119 (53.8%) patients. Operative intervention was conducted in 62 (52.1%) patients.
Conclusion. While conduction of ultrasonographic investigation by a surgeon-endocrinologist the rate of revealing of false-positive echographic signs have lowered in more than 2 times (1.4%), comparing with analogous index while conduction of the investigation by radiologist (3.1%). Application of a TI-RADS classification have permitted to reduce the rate of the fine-needle biopsy and doing of surgical interventions.
Bhatki AM, Brewer B, Robinson-Smith T, Nikiforov Y, Steward DL. Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy. Otolaryngol Head Neck Surg 2008;139(1):27-31. doi: 10.1177/0284185116649797.
Mazzaglia PJ. Surgeon-performed ultrasound in patients referred for thyroid disease improves patient care by minimizing performance of unnecessary procedures and optimizing surgical treatment. World J Surg 2010;34(6):1164-70. doi: 10.1007/s00268-010-0402.
Ezzat S, Sarti D, Cain D, Braunstein G. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154(16):1838-1840. PMİD: 8053752.
Cronan J. Thyroid Nodules: Is it time to turn off the US machines? Radiology. 2008;247(3):602 - 604. doi: 10.1148/radiol.2473072233.
Mit’kov VV. Practical guidance on ultrasound diagnostics. General ultrasound diagnosis. Moscow: Vidar Publ; 2011. 720 p. [InRussian]. ]
Velkoborski HJu, Jekker P, Maurer Ja, Mann V. Ultrasonic diagnostics of head and neck diseases. Moscow: MEDpress-inform; 2016.174 p. [InRussian].
Tessler FN, Middleton WD, Grant EG, Hoang JK. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14(5):587-95.doi: 10.1016/j.jacr.2017.01.046.
Tan G, Gharib H. Thyroid incidentalomas: management approaches to no palpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126(3):226-31. doi: 10.7326/0003-4819-126-3-199702010-00009.
Ugurlu S, Caglar E, Yesim T, Tanrikulu E, Can G, Kadioglu P. Evaluation of thyroid nodules in Turkish population. Intern Med. 2008;47(4): 205-9. doi: 10.17219/acem/60084.
Gharib H. editor Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc. 1994;69(1):44-9. doi: 10.1016/s0025-6196(12) 61611-5.
Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med;118(4):282-9. doi: 10.7326/0003-4819-118-4-199302150-00007.
Gharib H, Goellner J, Johnson D. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin Lab Med. 1993;13(3):699-709. doi: 10.1016/S0272-2712(18)30434-7.
Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, et al. Factors affesting inadequatesampling of ultrasoundguided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011;74(6):776-82. doi: 10.1111/j.1365-2265.2011.04011.x.
Eun NL, Yoo MR, Gweon HM, Park AY, Kim JA, Youk JH, et al. Thyroid nodules with nondiagnostic results on repeat fine-needle aspiration biopsy: which nodules should be considered for repeat biopsy or surgery rather than follow-up? Ultrasonography. 2016;35(3):234-43. doi: 10.14366/usg.15079
Moon HJ, Kim E-K, Kwak JY. Malignancy Risk Stratification in Thyroid Nodules with Benign Results on Cytology: Combination of Thyroid Imaging Reporting and Data System and Bethesda System. Ann Surg Oncol. 2014;21(6):1898-903. doi: 10.1245/s10434-014-3556-2.
Horvath E, Majlis S, Rossi R, Franco C, Niedmann J, Castro A. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748-51. doi: 10.1210/jc.2008-1724.
Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH,. Thyroid Imaging Reporting and Data System for US Features of Nodules: A Step in Establishing Better. Radiology. 2011; 260(3):892-9. doi: 10.1148/radiol.11110206.
Fish SA. ACR TIRADS is Best to Decrease the Number of Thyroid Biopsies and Maintain Accuracy Clin Thyroidol. 2019;31(3):113-6. doi: 10.1089/ct.2019;31.113-116.
Hoang JK, Middleton WD, Farjat AE, Langer JE, Reading CC, Teefey SA, et al. Reduction in thyroid nodule biopsies and improved accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. Radiology 2018;287(4):185-93. doi: 10.1148/radiol.2018172572.
Timofeeva LA, Aljoshina TN. The use of the TIRADS system in the differential diagnosis of thyroid cancer. Kazan Medical Journal. 2017;98(4): 632-6. (InRuss.)]
Aleksandrov YuK, Sergeev ED, Sencha AN. Peresmotr pokozaniy dlya biopsii uzlov shchitovidnoy zhelezy. Vestnik khirurgii. 2015;174(1):23-5 [In Russian].
Ali SZ, Cibas ES editors. The Bethesda System for Reporting Thyroid Cytopatology. Boston: Springer-Verlag; 2010. 171 p. doi: 10.1007/978-0-387-87666-5_7.
Staren ED, Knudson MM, Rozycki GS, Harness JK, Wherry DC, Shackford SR. An evaluation of the American College of Surgeons’ ultrasound education program. Am J Surg.2006 April; 191(4):489-96 doi: 10.1016/j.amjsurg.2005.10.023.
Solorzano CC, Carneiro DM, Ramirez M, Lee TM, Irvin GL 3rd. Surgeon performed ultrasound in the management of thyroid malignancy. Am Surg 2004;70(7):576-80. PMID: 15279178.
Milas M, Stephen A, Berber E, Wagner K, Miskulin J, Siperstein A. Ultrasonography for the endocrine surgeon: a valuable clinical tool that enhances diagnostic and therapeutic outcomes. Surgery 2005;138:1193-200. doi:10,1016/j.surg.2005.08.032.
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