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Endocrine Abstracts (2021) 73 AEP870 | DOI: 10.1530/endoabs.73.AEP870

ECE2021 Audio Eposter Presentations Late Breaking (114 abstracts)

Comparative analysis of five different ultrasonographical risk-stratification systems in the preoperative diagnosis of malignant and benign thyroid nodules

Fatma Dilek Dellal 1 , Abbas Ali Tam 2 , Şefika Burçak Polat 2 , Mustafa Omer Yazicioglu 3 , cevdet aydin 2 , Didem Ozdemir 2 , Afra Alkan 4 , Oya Topaloglu 2 , Reyhan Ersoy 2 & Bekir Cakir 2


1Ankara City Hospital, Endocrinology and Metabolism, Turkey; 2Ankara Yildirim Beyazit University, Faculty of Medicine, Endocrinology and Metabolism, Turkey; 3Ankara City Hospital, General Surgery, Turkey; 4Ankara Yildirim Beyazit University, Faculty of Medicine, Biostatistics, Turkey


Background

Our aim was to compare the effectiveness of five different risk-stratification systems using the ultrasonographical features of thyroid nodules in determining malignant histopathology.

Methods

The preoperative ultrasonography (US) features of 6925 nodules of 3030 patients who underwent thyroidectomy between 2007 and 2014 were analyzed retrospectively. The nodules were classified according to Kwak-TIRADS (Thyroid imaging reporting and data system), European Thyroid Association-TIRADS (EU-TIRADS), Korea-TIRADS, American Society of Clinical Endocrinologists (AACE), American Thyroid Association (ATA).1362 nodules (1042 patients) that could be scored in all of these systems were included. Malignancy rate, specificity, sensitivity, positive predictive value (PPV) and negative predictive value were calculated.

Results

In the nodules with high risk scored, malignant histopathology rate were 50%, 27.7%, 32.2%, 29.9%, 31.9% in Kwak-TIRADS, EU_TIRADS, Kore-TIRADS, AACE, ATA, respectively (Table 1). Area under curve (AUC) was higher than 0.5 for all systems (P <0.001, Table 2). When determining optimal cut-off for each system, sensitivity, specificity, PPV, and NPV were about 60%, 75%, 27–30% and 92%, respectively (Table 2). EU-TIRADS had significantly lower AUC (corrected P<0.05). AUC of Korea- TIRADS was lower than that of ATA (corrected-P<0.001). AUCs of Kwak-TIRADS, AACE, and ATA were similar and significantly higher than the others (Table 2).

Table-1.Distribution of benign and malignant nodules according to riskstratification systems
  Benign (n = 1179) Malignant (n = 183)
  n (%1/%2) n (%1/%2)
Kwak-TIRADS    
Possibly benign 137 (97.9/11.6) 3 (2.1/1.6)
Low 774 (91.8/65.7) 69 (8.2/37.7)
Intermediate 61 (82.4/5.2) 13 (17.6/7.1)
Moderate 195 (69.4/16.5) 86 (30.6/47.0)
High 12 (50.0/1.0) 12 (50.0/6.6)
EU-TIRADS    
Benign 97 (95.1/8.2) 5 (4.9/2.7)
Low 729 (91.8/61.9) 65 (8.2/35.5)
Intermediate 58 (100.0/4.9) 0 (0.0/0.0)
High 295 (72.3/25.0) 113 (27.7/61.8)
Kore-TIRADS    
Benign 129 (94.9/10.9) 7 (5.1/3.8)
Low 787 (92.4/66.8) 65 (7.6/35.5)
Intermediate 57 (81.4/4.8) 13 (18.6/7.1)
High 206 (67.8/17.5) 98 (32.2/53.6)
AACE    
Low 187 (96.4/15.9) 7 (3.6/3.8)
Intermediate 729 (91.9/61.8) 64 (8.1/35.0)
High 263 (70.1/22.3) 112 (29.9/61.2)
ATA    
Bening 129 (94.9/10.9) 7 (5.1/3.8)
Very low 58 (100.0/4.9) 0 (0.0/0.0)
Low 729 (91.8/61.9) 65 (8.2/35.5)
Intermediate 54 (80.6/4.6) 13 (19.4/7.1)
High 209 (68.1/17.7) 98 (31.9/53.6)
1 Row percentage; 2Column percentage.
Table-2. ROC curve analysis results
  Cut-off Specificity Sensitivity PPV NPV AUC 95% CI
Kwak-TIRADS intermadiate 60.7% 77.3% 29.3% 92.7 0.717 0.680–0.754
EU-TIRADS high 61.7% 75.0% 27.7% 92.7 0.680 0.641–0.719
Kore-TIRADS intermadiate 60.7% 77.7% 29.7% 92.7 0.705 0.666–0.744
AACE high 61.2% 77.7% 29.9% 92.8 0.710 0.674–0.747
ATA intermadiate 60.7% 77.7% 29.7% 92.7 0.713 0.675–0.751

Conclusion

Risk-stratification systems have variable efficiency in predicting malignancy risk since they are operator dependent and require experience in that field. The sensitivity was found to be lower than the previous studies which might be due to retrospective evaluation of US reports rather than real time risk scoring.

Volume 73

European Congress of Endocrinology 2021

Online
22 May 2021 - 26 May 2021

European Society of Endocrinology 

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