Efficacy analysis between ultrasound and cytology criteria in the differentiation of malignant and benign thyroid nodules: TIRADS versus BETHESDA

Year 2023, Volume: 6 Issue: 2, 405 - 409, 27.03.2023

Muzaffer Serdar Deniz , Kutay Sarı , Oğuz Özturk

https://doi.org/10.32322/jhsm.1229238

Abstract

Aim: Thyroid nodules (TNs) are abnormal masses of different structures and sizes to be detected promptly. The present study aimed to investigate the relationship between Bethesda and TIRADS and their diagnostic efficiency in histopathologically diagnosed malign TNs.
Material and Method: 475 patients with TNs enrolled in this cross-sectional research. Laboratory parameters and clinical thyroid history were obtained from the automation system and analyzed retrospectively. They have been staged according to TIRADS, and the neck is evaluated in suspicious lymph nodes. FNAB results are then tracked for Bethesda staging.
Results: TIRADS showed a good sensitivity at the rate of 74.5% and average specificity at 68.1% for TNs. Bethesda had a higher sensitivity at 80.1% and 95.2% specificity rates. The positive predictive (98.1 vs. 88.2) and negative predictive (13 vs. 23.6) values were higher for Bethesda than TIRADS. The diagnostic accuracy for Bethesda was 79%. According to the ROC, Bethesda had a more expansive area under curve (0.81) than TIRADS (0.63). FNAC was a better diagnostic method than ultrasonography in evaluating thyroid nodules (p<0.001).
Conclusion: The risk of malignancy increased parallel to the increased Bethesda and TIRADS. While both scores helped predict malignancy, Bethesda is essential to physicians in assisting the discrimination of malign and benign TNs.

Keywords

Thyroid nodule, malignancy, TIRADS, Bethesda, Ultrasound

References

• de Siqueira RA, Rodrigues A, Miamae LM, Tomimori EK, Silveira EA. Thyroid nodules in severely obese patients: frequency and risk of malignancy on ultrasonography. Endocr Res 2020; 45: 9-16.
• Daniels KE, Xu J, Liu JB, et al. Diagnostic value of TI-RADS classification system and next generation genetic sequencing in indeterminate thyroid nodules. Acad Radiol 2021; 28: 1685-91.
• Gungor K, Dokuzeylul Gungor N. Antithyroid antibodies may predict serum beta HCG levels and biochemical pregnancy losses in euthyroid women with IVF single embryo transfer. Gynecol Endocrinol 2021; 37: 702-5.
• Zhu Y, Sang Q, Jia S, Wang Y, Deyer T. Deep neural networks could differentiate Bethesda class III versus class IV/V/VI. Ann Transl Med 2019; 7: 231.
• Bian J, Wang R, Lin M. Ultrasonic S-Detect mode for the evaluation of thyroid nodules: A meta-analysis. Medicine (Baltimore) 2022; 101: e29991.
• Staibano P, Forner D, Noel CW, et al. Ultrasonography and fine-needle aspiration in indeterminate thyroid nodules: a systematic review of diagnostic test accuracy. Laryngoscope 2022; 132: 242-51.
• Ferrarazzo G, Camponovo C, Deandrea M, Piccardo A, Scappaticcio L, Trimboli P. Suboptimal accuracy of ultrasound and ultrasound-based risk stratification systems in detecting medullary thyroid carcinoma should not be overlooked. Findings from a systematic review with meta-analysis. Clin Endocrinol (Oxf) 2022; 97: 532-40.
• Nie W, Zhu L, Yan P, Sun J. Thyroid nodule ultrasound accuracy in predicting thyroid malignancy based on TIRADS system. Adv Clin Exp Med 2022; 31: 597-606.
• Xie M, Gupta MK, Archibald SD, Jackson BS, Massey Ted Young JE, Zhang H. The usefulness of the thyroid imaging reporting and data system in determining thyroid malignancy. Laryngoscope 2020; 130: 2087-91.
• Hu Y, Xu S, Zhan W. Diagnostic performance of C-TIRADS in malignancy risk stratification of thyroid nodules: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13: 938961.
• Zloczower E, Atas O, London D, Elharar L, Jacobe-Levy M, Marom T. Agreement between Ti-RADS classification and bethesda cytopathological findings from thyroid nodules in young adults. Mil Med 2020; 185: 2020-5.
• Bayona A, Benavent P, Muriel A, et al. Outcomes of repeat fineneedle aspiration biopsy for AUS/FLUS thyroid nodules. Eur J Endocrinol 2021; 185: 497-506.
• Vuong HG, Chung DGB, Ngo LM, et al. The use of the bethesda system for reporting thyroid cytopathology in pediatric thyroid nodules: a meta-analysis. Thyroid 2021; 31: 1203-11.
• Mendes GF, Garcia MR, Falsarella PM, et al. Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: accuracy of TIRADS classification system in more than 1000 nodules. Br J Radiol 2018; 91: 20170642.
• Abdelkader AM, Zidan AM, Younis MT, Dawa SK. Preoperative evaluation of thyroid nodules: a prospective study comparing the accuracy of ultrasound (TI-RADS) versus the FNAC bethesda system in relation to the final postoperative histo-pathological diagnosis. Ann Pathol Lab Med 2018; 5: A801-9.
• Singaporewalla RM, Hwee J, Lang TU, Desai V. Clinico-pathological correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World J Surg 2017; 41: 1807-11.
• George NA, Suresh S, Jiji V, et al. Correlation of TIRADS and bethesda scoring systems with final histopathology of thyroid nodules – an institutional experience. Indian J Otolaryngol and Head Neck Surg 2021.
• Kaliszewski K, Diakowska D, Wojtczak B, et al. Fine-needle aspiration biopsy as a preoperative procedure in patients with malignancy in solitary and multiple thyroid nodules. PLoS One 2016; 11: e0146883-e.
• Horvath E, Silva CF, Majlis S, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. European Radiology 2016; 27: 2619-28.
• Periakaruppan G, Seshadri KG, Vignesh Krishna GM, Mandava R, Sai VPM, Rajendiran S. Correlation between Ultrasound-based TIRADS and Bethesda System for Reporting Thyroid-cytopathology: 2-year Experience at a Tertiary Care Center in India. Indian J Endocrinol Metab 2018; 22: 651-5.
• Yilmaz S, BÖLÜKbaŞI H. Tiroid Kanseri Tanısında ACR-TIRADS Skorlama Sistemi ile Bethesda Sınıflama Sisteminin Birlikte Kullanımının Önemi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2021; 74: 134-8.