Correlation of ultrasound and cytological diagnosis of thyroid nodule using TIRADS and bethesda classifications

Öz

Aim: The objective of this study was to evaluate the compatibility between the two diagnostic methods used in the initial evaluation of individuals with a thyroid nodule, the TIRADS and Bethesda systems. Material and Methods: Between January 2020 and December 2022, FNA biopsies performed by a single interventional radiologist on 414 patients with thyroid nodules under US guidance were retrospectively reviewed. Demographic information of the patients, size of the nodules, echogenicity, TIRADS and BETHESDA scores were recorded and analyzed. Results: The mean age of the study population was 50.4 ± 14.2 years and the majority were female patients (74.9%). When thyroid nodules were classified according to TRIADS criteria, it was TIRADS TR2 in 29 (7%) patients, TIRADS TR3 in 147 (35.5%) patients, TR4 in 166 (40.1%) patients, and TR5 in 72 (17.4%) patients. The probability of malignant FNAC (Bethesda Class V and Class VI) in TIRADS classes 2, 3, 4, and 5 was 0%, 3.4%, 31.3%, and 66.7%, respectively. The probability of a benign FNAC (Bethesda Class II) in TIRADS category 2 was 100%, while for TIRADS classes 3, 4 and 5 it was 81.6%, 34.9% and 25%, respectively. Conclusion: Our study shows a good correlation between the Bethesda Classification of thyroid nodule FNAC and thyroid ultrasound reporting using the TIRADS classification. Correct interpretation of the two findings helps the clinician reduce the risk of unnecessary invasive procedures in patients who are unlikely to demonstrate thyroid cancer, while facilitating the identification of patients at high risk of cancer.

Anahtar Kelimeler

• Fine-needle aspiration cytology
• Thyroid nodules
• TIRADS
• Bethesda
• Ultrasonography

TIRADS ve bethesda sınıflandırmaları kullanılarak tiroid nodülünün ultrason ve sitolojik tanısının korelasyonu

Öz

Amaç: Tiroid nodülü olan bireylerin ilk değerlendirmesinde kullanılan iki tanı yöntemi TIRADS ve Bethesda sistemleri arasındaki uyumu değerlendirmektir. Gereç ve Yöntemler: Ocak 2020 ve Aralık 2022 yılları arasında tek bir girişimsel radyolog tarafından US kılavuzluğunda yapılan 414 tiroid nodüllü hastaya yapılan İİA biyopsileri retrosepektif olarak incelendi. Hastaların demografik bilgileri, nodüllerin boyutu, ekojenitesi ve kontur durumu, TIRADS ve BETHESDA skorları kaydedildi ve analiz edildi. Bulgular: Çalışma popülasyonunun ortalama yaşı 50.4 ± 14.2 idi ve çoğunluğu kadın hastalardı (%74.9). Hastaların ortalama nodül boyutu 18.36 ± 12.96 mm olarak ölçüldü. Tiroid nodülleri TRIADS kriterlerine göre sınıflandırıldığında 29 (%7) hastada TIRADS TR2, 147 (%35.5) hastada TIRADS TR3, 166 (%40.1) hastada TR4 ve 72 (%17.4) hastada TR5 idi. TIRADS 2, 3, 4 ve 5 sınıflarında Bethesda Class V ve Class VI olasılığı sırasıyla %0, %3.4, 31.3 ve %66.7 idi. TIRADS kategori 2'de Bethesda Sınıf II olasılığı %100 iken, TIRADS 3, 4 ve 5 sınıfları için sırasıyla %81.6, %34.9 ve %25 idi. Sonuçlar: Çalışmamız, tiroid nodülü İİAS'nin Bethesda Sınıflandırması ile TIRADS sınıflandırmasını kullanan tiroid ultrason raporlaması arasında oldukça iyi bir korelasyon olduğunu göstermektedir. İki bulgunun doğru yorumlanması, klinisyenin tiroid kanseri gösterme olasılığı düşük olan hastalarda gereksiz invaziv prosedür riskini azaltmasına yardımcı olurken, yüksek kanser riski taşıyan hastaların belirlenmesini kolaylaştırır.

Anahtar Kelimeler

• İnce iğne aspirasyon sitolojisi
• Tiroid nodülleri
• TIRADS
• Bethesda
• Ultrasonografi

Kaynakça

1. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167-214.
2. Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines for patients with thyroid nodules and well‑differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 1996;156:2165‑72.
3. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328:553‑9.
4. 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(5):651–5.
5. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med1994;154:1838‑40.
6. De Matos PS, Ferreira AP, Ward LS. Prevalence of papillary microcarcinoma of the thyroid in Brazilian autopsy and surgical series. Endocr Pathol 2006;17:165‑73.
7. Kovacs GL, Gonda G, Vadasz G, et al. Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. Thyroid 2005;15:152‑7.
8. 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.

9. National Comprehensive Cancer Network. Thyroid cancer (Version 2.2020). https://www.nccn.org/patients/guidelines/content/PDF/ thyroid-patient.pdf. Plymouth Meeting, USA; 2020.
10. Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. (2015) Journal of the American College of Radiology : JACR. 12 (12 Pt A): 1272-9.
11. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009;94:1748‑51.
12. Vargas-Uricoechea H, Meza-Cabrera I, Herrera-Chaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid Res. 2017;10:1.
13. Pusztaszeri M, Rossi ED, Auger M, et al. The Bethesda system for reporting thyroid cytopathology: proposed modifications and updates for the second edition from an international panel. Acta Cytol. 2016;60(5):399–405.
14. Garg S, Desai NJ, Mehta D, Vaishnav M. To establish bethesda system for diagnosis of thyroid nodules on the basis of fnac with histopathological correlation. J Clin Diagn Res. 2015;9(12):EC17–21.
15. Park JY, Lee HJ, Jang HW et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinomoa. Thyroid 2009; 19(11):1257–64
16. 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(5):651–5.
17. Chandramohan A, Khurana A, Pushpa BT, Manipadam MT, Naik D, Thomas N, et al. Is TIRADS a practical and accurate system for use in daily clinical practice? The Indian Journal of Radiology and Imaging. 2016;26:145-52.
18. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid Imaging Reporting and Data System for Ultrasound Features of Nodules: A Step in Establishing Better Stratification of Cancer Risk. Radiology 2011;260:892‑9.
19. Aksoy SH, Uygun O, Yurdaisik I, Ates L, Aydin S. The relationship between ultrasound-based TIRADS and BETHESDA categories in patients undergoing thyroid biopsy. Clin Exp Med. 2022;22(4):661-6.