Thyroid Imaging Reporting and Data System (TIRADS) in Stratifying Risk of Thyroid Malignancy at The Medical City

Joanna Grace Dy, Ruben Kasala, Christy Yao, Renncee Ongoco, Dondee Jules Mojica

Abstract

Objective. To determine the accuracy of Thyroid Imaging Reporting and Data System (TIRADS) in detecting thyroid malignancy, determine risk of malignancy in each TIRADS category and determine the ultrasound characteristics associated with malignancy.

Methodology. This is a retrospective cross-sectional study involving patients who underwent ultrasound, thyroid fine needle aspiration biopsy (FNAB) and thyroidectomy at The Medical City from January 2014 to December 2015. Ultrasound reports were retrieved and reviewed by two radiologists on separate occasions who were blinded to the cytopathology and histopathology results. The histopathology reports were correlated with ultrasound features to determine features associated with malignancy. Stata SE 12 was used for data analysis. TIRADS sensitivity, specificity, positive predictive values and negative predictive values and accuracy were calculated.

Results. 149 patients with thyroid nodules were included. Solid composition is the ultrasound feature predictive of malignancy with adjusted OR 4.912 (95% Cl 1.3257 to 18.2011, p = 0.017). The risk of malignancy for TIRADS categories 3, 4a, 4b, 4c and 5 were 12.50%, 12.82%, 26.19%, 53.70% and 66.67%, respectively. The Crude OR (95% CI) for TIRADS 4a, 4b, 4c and 5 were 1.03 (0.10 to 10.23), 2.48 (0.27 to 22.54), 8.12 (0.93 to 70.59) and 14.0 (0.94 to 207.60), respectively. The sensitivity, specificity, PPV, NPV and accuracy of TIRADS in relation to surgical histopathology report were 98.00%, 7.07%, 34.75%, 87.50%, and 53% respectively in TIRADS categories 4 and 5.

Conclusion. This study showed that a solid nodule is the most frequent ultrasound feature predictive of thyroid malignancy. Higher TIRADS classification is associated with higher risk of thyroid malignancy. TIRADS is a sensitive classification in recognizing patients with thyroid cancer.

Keywords

thyroid imaging reporting and data system, histopathology, thyroid cancer, malignancy risk

Full Text:

Abstract HTML

References

Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994; 154(16):1838-40. PMID: 8053752.

Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clnical Endocrinol Metab. 2008; 22(6):901-11. PMID: 19041821. https://doi.org/10.1016/j.beem.2008.09.019.

Carlos-Raboca J, Jimeno C, Kho S, et al. The Philippine Thyroid Disease Study (PhilTiDes 1): Prevalence of thyroid disorders among adults in the Philippines. J ASEAN Fed Endocr Soc. 2012;27(2):27-33. https://doi.org/10.15605/jafes.027.01.04.

Haugen BR, Alexander EK, Bible KC, et. al.. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133. PMID: 26462967. PMCID: PMC4739132.

https://doi.org/10.1089/thy.2015.0020.

Muratli,A, Erdogan N, Sevim, S, Unal, I, Akyuz S. Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. J Cytol. 2014;31(2):73-8. PMID: 25210233. PMCID: PMC4159900. https://doi.org/10.4103/0970-9371.138666.

Chowdhury J, Das S, Maji D. A study on thyroid nodules: Diagnostic correlation between fine needle aspiration cytology and histopathology. J Indian Med Assoc. 2008;106(6):389-90. PMID: 18839651.

Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology, Am J Clin Pathol. 2009;132(5):658-65. PMID: 19846805. https://doi.org/10.1309/AJCPPHLWMI3JV4LA.

Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et. al. An ultrasound reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748-51. PMID: 19276237. https://doi.org/10.1210/jc.2008-1724.

Park JY, Lee HJ, Jang, HW, et. al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009;19(11):1257-67. PMID: 19754280. https://doi.org/10.1089/thy.2008.0021.

Kwak JY, Kim HH, Yoon, JH, Moon HJ, Son EJ, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology. 2011;260(3):892-9. https://doi.org/10.1148/radiol.11110206.

American College of Radiology. Breast imaging reporting and data system, breast imaging atlas . 4th ed. Roston Va: American College of Radiology, 2003.

Goodman MT, Yoshizawa CN, Kolonel LN. Descriptive epidemiology of thyroid cancer in Hawaii. Cancer. 1988;61(6):1272–81. PMID: 3342383.

Haselkorn T, Bernstein L, Preston-Martin S, Cozen W, Mack WJ. Descriptive epidemiology of thyroid cancer in Los Angeles County, 1972-1995. Cancer Causes Control. 2000;11(2):163–70. PMID: 10710201. https://doi.org/10.1023/A:1008932123830.

Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, et al. Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst. 2013;105(15):1096–110. PMID: 23878350. PMCID: PMC3735462. https://doi.org/10.1093/jnci/djt157.

Puno-Ramos MPG, Villa ML, Kasala RG, Arzadon J, Alcazaren EAS. Ultrasound features of thyroid nodules predictive of thyroid malignancy as determined by fine needle aspiration biopsy. Philipp J Intern Med. 2015;53(2):1-8.

Cañete EJ, Sison-Peña CM, Jimeno CA. Clinicopathological, biochemical, and sonographic features of thyroid nodule predictive of malignancy among adult Filipino patients in a tertiary hospital in the Philippines. Endocrinol Metab (Seoul). 2014;29(4):489-97. PMCID: PMC4285043. https://doi.org/10.3803/EnM.2014.29.4.489.

Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency ultrasound examination. Eur J Clin Investig. 2009;39(8):699-706. PMID: 19601965. https://doi.org/10.1111/j.1365-2362.2009.02162.x.

Smith-Bindman R, Lebda P, Feldstein V, Sellami, D, Goldstein RB, Brasic N, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: Results of a population-based study. JAMA Intern Med. 2013;173(19):1788-96. PMID: 23978950. PMCID: PMC3936789. https://doi.org/10.1001/jamainternmed.2013.9245.

Remonti LR, Kramer CK, Leitao CB, Pinto LCF, Gross JL. Thyroid ultrasound features and risk of carcinoma: A systematic review and meta-analysis of observation studies. Thyroid. 2015;25(5):538-50. PMID: 25747526 PMCID: PMC4447137. https://doi.org/10.1089/thy.2014.0353.

Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: A meta-analysis. Acta Cytol. 2012;56(4):333-9. PMID: 22846422. https://doi.org/10.1159/000339959.

Srinivas MNS, Amogh VN, Gautam MS, Prathyusha IS, Vikram NR, Retnam MK, et al. A prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions. J Clin Imaging Sci. 2016;6:5. PMID: 27014501. PMCID: PMC4785791. https:doi.org/10.4103/2156-7514.177551.

Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A multicenter prospective validation study for the Korean thyroid imaging reporting and data system in patients with thyroid nodules. Korean J Radiol. 2016;17(5):811-21. PMCID: PMC5007410. https://doi.org/10.3348/kjr.2016.17.5.811.

Horvath E, Silva CF, Majlis S, Rodriguez I, Skoknic V, Castro A, et al. Prospective validation of the ulrasound based TIRADS (Thyroid imaging and reporting data system) classification: Results in surgically resected thyroid nodules. Eur Radiol. 2017;27(6):2619-28. PMID: 27718080. https://doi.org/10.1007/s00330-016-4605-y.

Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: Comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association management guidelines. Radiology. 2016;278(3):917-24. PMID: 26348102. https://doi.org/10.1148/radiol.2015150056.

Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leehardt L. Prospective evaluation of thyroid imaging and data system on 4550 nodules with or without elastography. Eur J Endocrinol. 2013;168(5):649-55. PMID: 23416955. https://doi.org/10.1530/EJE-12-0936.

Altman DG, Bland JM. Diagnostic tests 2: Predictive values. BMJ. 1994; 309(6947):102. PMID: 8038641. PMCID: PMC2540558.