Correct and Incorrect Recommendations for or against Fine Needle Biopsies of Hypofunctioning Thyroid Nodules: Performance of Different Ultrasound-based Risk Stratification Systems

Abstract

Purpose To evaluate the recommendations for or against fine needle biopsy (FNB) of hypofunctioning thyroid nodules (TNs) using of five different Ultrasound (US) -based risk stratification systems (RSSs).

Methods German multicenter study with 563 TNs (≥ 10 mm) in 534 patients who underwent thyroid US and surgery. All TNs were evaluated with ACR TI-RADS, EU-TIRADS, ATA, K-TIRADS 2016 and modified K-TIRADS 2021. A correct recommendation was defined as: malignant TN with recommendation for FNB (appropriate) or benign TN without recommendation for FNB (avoided). An incorrect recommendation was defined as: malignant TN without recommendation for FNB (missed) or benign TN with recommendation for FNB (unnecessary).

Results ACR TI-RADS demonstrated the highest rate of correct (42.3 %) and lowest rate of incorrect recommendations (57.7 %). The other RRSs showed similar results for correct (26.5 %–35.7 %) and incorrect (64.3 %–73.5 %) recommendations. ACR TI-RADS demonstrated the lowest rate of unnecessary (73.4 %) and the highest rate of appropriate (26.6 %) FNB recommendation. For other RSSs, the rates of unnecessary and appropriate FNB were between 75.2 %–77.1 % and 22.9 %–24.8 %. The lowest rate of missed FNB (14.7 %) and the highest rate of avoided FNB (85.3 %) was found for ACR TI-RADS. For the other RSSs, the rates of missed and avoided FNB were between 17.8 %–26.9 % and 73.1 %–82.2 %. When the size cutoff was disregarded, an increase of correct recommendations and a decrease of incorrect recommendations was observed for all RSSs.

Conclusion The RSSs vary in their ability to correctly recommend for or against FNB. An understanding of the impact of nodule size cutoffs seems necessary for the future of TIRADS.

Zusammenfassung

Die RSS zeigen im Hinblick auf die jeweilige korrekte Empfehlung zur FNB eine erhebliche Heterogenität (Variabilität). Inwiefern bzw. wie stark ein Cutoff bei der Knotengröße, sich auswirkt muss zukünftig bei TIRADS evaluiert werden.

Key words

thyroid nodule - thyroid cancer - ultrasound - fine needle biopsy - risk stratification systems - Thyroid Imaging Reporting And Data System

Schlüsselwörter

Schilddrüsenknoten - Schilddrüsenkarzinom - Feinnadelbiopsie - Risikostratifizierungssysteme - Thyroid Imaging Reporting And Data System

Publication History

Received: 14 June 2023

Accepted: 18 September 2023

Article published online:
23 October 2023

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