Cargando…

A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions

OBJECTIVES: To evaluate diagnostic reliability of the daily use of thyroid imaging reporting and data system (TIRADS) classification proposed by Kwak et al., in differentiating between a benign and a malignant thyroid lesion, to calculate inter-observer variability in the interpretation of each of t...

Descripción completa

Detalles Bibliográficos
Autores principales: Srinivas, M Naren Satya, Amogh, V N, Gautam, Munnangi Satya, Prathyusha, Ivvala Sai, Vikram, N R, Retnam, M Kamala, Balakrishna, B V, Kudva, Narendranath
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785791/
https://www.ncbi.nlm.nih.gov/pubmed/27014501
http://dx.doi.org/10.4103/2156-7514.177551
_version_ 1782420470321119232
author Srinivas, M Naren Satya
Amogh, V N
Gautam, Munnangi Satya
Prathyusha, Ivvala Sai
Vikram, N R
Retnam, M Kamala
Balakrishna, B V
Kudva, Narendranath
author_facet Srinivas, M Naren Satya
Amogh, V N
Gautam, Munnangi Satya
Prathyusha, Ivvala Sai
Vikram, N R
Retnam, M Kamala
Balakrishna, B V
Kudva, Narendranath
author_sort Srinivas, M Naren Satya
collection PubMed
description OBJECTIVES: To evaluate diagnostic reliability of the daily use of thyroid imaging reporting and data system (TIRADS) classification proposed by Kwak et al., in differentiating between a benign and a malignant thyroid lesion, to calculate inter-observer variability in the interpretation of each of the TIRADS ultrasound features and to evaluate role of TIRADS system in reducing unnecessary biopsies of benign lesions. MATERIALS AND METHODS: Three hundred and sixty-five patients with clinically suspected thyroid lesions during the period from November 1, 2011, to August 31, 2015, were prospectively scanned on gray-scale and Doppler imaging by six radiologists separately. We used GE VOLUSON 730 PRO machine (GE healthcare, Milwaukee, USA) equipped with a 7.5–12 MHz high-frequency linear array transducer with color and power Doppler capability. We evaluated five sonological features: Internal composition, echogenicity, margins, presence and type of calcification, and shape of the lesion. Based on the TIRADS proposed by Kwak et al., we determined categories of the thyroid lesions. The diagnostic performance of TIRADS classification system was evaluated by comparison with the fine-needle aspiration cytology (FNAC) reports which were subsequently obtained after taking informed consent from the patients. All follicular neoplasms on FNAC were further followed up with excision biopsy and histology. The cytopathological report was used as the standard final diagnosis for comparison. The P value and odds ratio were determined to quantify how strongly the presence or absence of a particular ultrasound feature was associated with benignity or malignancy in the study population. The risk of malignancy was stratified for each TIRADS category-based on the total number of benign and malignant lesions in that category. Cervical lymph nodes were also evaluated for their size, loss of the central, echogenic hilum, presence of irregular and indistinct margin, microcalcification, and necrotic changes. Cohen's Kappa coefficient was determined separately for each of the five TIRADS malignant features to study the inter-observer agreement. Furthermore, the percentage of benign cases that were accurately determined by TIRADS which could have avoided unnecessary FNAC was determined. RESULTS: The risk of malignancy in TIRADS categories 1 and 2 was found to be 0%, 0.64% in category 3, 4.76% in category 4A, 66.67% in category 4B, 83.33% in category 4C, and 100% in category 5. Out of the five suspicious sonological features, irregular margins showed the highest positive predictive value (95.45%) for malignancy followed by taller than wide shape (92.86%), microcalcifications (66.67%), marked hypoechogenicity (54.55%), and solid composition (48.15%). The specificity of three sonological features (completely cystic structure, hyperechogenicity, and macrocalcification) in classifying a nodule as benign was 100%. Loss of central echogenic hilum, presence of an irregular and indistinct margin, microcalcification and necrosis were found to have sensitivity of 100%, 63.63%, 27.27%, and 9.09%, respectively and specificity of 95.7%, 98.5%, 100%, and 100%, respectively for cervical lymph node to be malignant. The Kappa value for taller than wide shape, microcalcification, marked hypoechogenicity, solid composition, and irregular margins was 1.0 (95% confidence interval [CI]: 1–1), 1.0 (95% CI: 1–1), 0.90 (95% CI: 0.82–1), 0.88 (95% CI: 0.77–0.92), and 0.82 (95% CI: 0.64–1), respectively. The estimated decrease in unnecessary FNACs was found to be 43.83–86.30%. CONCLUSIONS: TIRADS proposed by Kwak et al., combined with evaluation for sonological features of malignant lymph nodes is a valuable, safe, widely available, and easily reproducible imaging tool to stratify the risk of a thyroid lesion and helps in precluding unnecessary FNACs in a significant number of patients. TIRADS features convincingly show comparable results in the interpretation of TIRADS features more so, in the hands of radiologists experienced in thyroid imaging.
format Online
Article
Text
id pubmed-4785791
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-47857912016-03-24 A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions Srinivas, M Naren Satya Amogh, V N Gautam, Munnangi Satya Prathyusha, Ivvala Sai Vikram, N R Retnam, M Kamala Balakrishna, B V Kudva, Narendranath J Clin Imaging Sci Original Article OBJECTIVES: To evaluate diagnostic reliability of the daily use of thyroid imaging reporting and data system (TIRADS) classification proposed by Kwak et al., in differentiating between a benign and a malignant thyroid lesion, to calculate inter-observer variability in the interpretation of each of the TIRADS ultrasound features and to evaluate role of TIRADS system in reducing unnecessary biopsies of benign lesions. MATERIALS AND METHODS: Three hundred and sixty-five patients with clinically suspected thyroid lesions during the period from November 1, 2011, to August 31, 2015, were prospectively scanned on gray-scale and Doppler imaging by six radiologists separately. We used GE VOLUSON 730 PRO machine (GE healthcare, Milwaukee, USA) equipped with a 7.5–12 MHz high-frequency linear array transducer with color and power Doppler capability. We evaluated five sonological features: Internal composition, echogenicity, margins, presence and type of calcification, and shape of the lesion. Based on the TIRADS proposed by Kwak et al., we determined categories of the thyroid lesions. The diagnostic performance of TIRADS classification system was evaluated by comparison with the fine-needle aspiration cytology (FNAC) reports which were subsequently obtained after taking informed consent from the patients. All follicular neoplasms on FNAC were further followed up with excision biopsy and histology. The cytopathological report was used as the standard final diagnosis for comparison. The P value and odds ratio were determined to quantify how strongly the presence or absence of a particular ultrasound feature was associated with benignity or malignancy in the study population. The risk of malignancy was stratified for each TIRADS category-based on the total number of benign and malignant lesions in that category. Cervical lymph nodes were also evaluated for their size, loss of the central, echogenic hilum, presence of irregular and indistinct margin, microcalcification, and necrotic changes. Cohen's Kappa coefficient was determined separately for each of the five TIRADS malignant features to study the inter-observer agreement. Furthermore, the percentage of benign cases that were accurately determined by TIRADS which could have avoided unnecessary FNAC was determined. RESULTS: The risk of malignancy in TIRADS categories 1 and 2 was found to be 0%, 0.64% in category 3, 4.76% in category 4A, 66.67% in category 4B, 83.33% in category 4C, and 100% in category 5. Out of the five suspicious sonological features, irregular margins showed the highest positive predictive value (95.45%) for malignancy followed by taller than wide shape (92.86%), microcalcifications (66.67%), marked hypoechogenicity (54.55%), and solid composition (48.15%). The specificity of three sonological features (completely cystic structure, hyperechogenicity, and macrocalcification) in classifying a nodule as benign was 100%. Loss of central echogenic hilum, presence of an irregular and indistinct margin, microcalcification and necrosis were found to have sensitivity of 100%, 63.63%, 27.27%, and 9.09%, respectively and specificity of 95.7%, 98.5%, 100%, and 100%, respectively for cervical lymph node to be malignant. The Kappa value for taller than wide shape, microcalcification, marked hypoechogenicity, solid composition, and irregular margins was 1.0 (95% confidence interval [CI]: 1–1), 1.0 (95% CI: 1–1), 0.90 (95% CI: 0.82–1), 0.88 (95% CI: 0.77–0.92), and 0.82 (95% CI: 0.64–1), respectively. The estimated decrease in unnecessary FNACs was found to be 43.83–86.30%. CONCLUSIONS: TIRADS proposed by Kwak et al., combined with evaluation for sonological features of malignant lymph nodes is a valuable, safe, widely available, and easily reproducible imaging tool to stratify the risk of a thyroid lesion and helps in precluding unnecessary FNACs in a significant number of patients. TIRADS features convincingly show comparable results in the interpretation of TIRADS features more so, in the hands of radiologists experienced in thyroid imaging. Medknow Publications & Media Pvt Ltd 2016-02-26 /pmc/articles/PMC4785791/ /pubmed/27014501 http://dx.doi.org/10.4103/2156-7514.177551 Text en Copyright: © 2016 Journal of Clinical Imaging Science http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Srinivas, M Naren Satya
Amogh, V N
Gautam, Munnangi Satya
Prathyusha, Ivvala Sai
Vikram, N R
Retnam, M Kamala
Balakrishna, B V
Kudva, Narendranath
A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title_full A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title_fullStr A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title_full_unstemmed A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title_short A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions
title_sort prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785791/
https://www.ncbi.nlm.nih.gov/pubmed/27014501
http://dx.doi.org/10.4103/2156-7514.177551
work_keys_str_mv AT srinivasmnarensatya aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT amoghvn aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT gautammunnangisatya aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT prathyushaivvalasai aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT vikramnr aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT retnammkamala aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT balakrishnabv aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT kudvanarendranath aprospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT srinivasmnarensatya prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT amoghvn prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT gautammunnangisatya prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT prathyushaivvalasai prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT vikramnr prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT retnammkamala prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT balakrishnabv prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions
AT kudvanarendranath prospectivestudytoevaluatethereliabilityofthyroidimagingreportinganddatasystemindifferentiationbetweenbenignandmalignantthyroidlesions