ETA2023 Poster Presentations Thyroid hormone diagnostics 2 (9 abstracts)
Does hypoechogenicity, as a single variable in decision of FNA, offer similar sensitivity and specificity as the elaborate tirads in the 10-20 mm range of thyroid nodules for cancer detection?
Tamás Solymosi 1 , Steen Joop Bonnema 2 , Andrea Frasoldati 3 , Laszlo Hegedüs 4 , Dr Laszlo Jambor 5 , Zsolt Karanyi 6 , Gábor László Kovács 7 , Enrico Papini 8 , Karoly Rucz 9 , Gilles Russ 10 & Endre Nagy 11
1Bugat Pal Hospital, Gyöngyös, Hungary; 2Department of Endocrinology and Metabolism, Odense University Hospital, Department of Endocrinology, Odense University Hospital, Denmark, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark; 3Department of Endocrinology, Azienda Ospedaliera Santa Maria Nuova DI Reggio Emilia, Italy, Endocrinology Unit of Arcispedale S. Maria Nuova, Reggio Emilia, Italy, Italy; 4Department Endocrinol. Odense Uni. Hosp., Odense University, Odense University Hospital, Odense, Denmark; 5University of Debrecen, Department of Radiology, Faculty of Medicine; 6University of Debrecen, Division of Endocrinology, Department of Medicine, Faculty of Medicine; 7Department of Internal Medicine, Flor Ferenc Hospital, Kistarcsa, Hungary; 8Department of Endocri. & Metabol. Disease, Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy, Ospedale Regina Apostolorum, Albano Roma, Italy; 9Ist Department of Medicine, University of Pecs, Ifjusag 13, H-7624 Pecs, Hungary; 10Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitie Salpetriere Hospital, Sorbonne University, Paris, France; 11Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Background: Widespread use of imaging has led to the detection of an increasing number of thyroid nodules. Thyroid societies have recommended the use of Thyroid Imaging, Reporting and Data System (TIRADS). However, there is a multitude of such risk stratification systems (RSS) for selecting thyroid nodules for FNA. They may be time consuming and consensus on thyroid nodule descriptors lacks. Also studies have suggested that operators’ experience may not be inferior to using a formal RSS evaluation in this context.
Objective: During nodule selection for FNA, <10 mm nodules may be left unsampled, while most nodules >20 mm require FNA irrespective of TIRADS score. We hypothesized that in the 10 to 20 mm thyroid nodule diameter range, where TIRADS score almost exclusively matters, nodule echogenicity, as a stand-alone descriptor, might provide comparable performance to the more complex approaches.
Patients and Methods: Seven highly experienced investigators from four countries evaluated, online, the ultrasound video-recordings of 123 histologically verified thyroid nodules by answering 17 thyroid nodule characteristics-related questions. The diagnostic performances of the most used five TIRADS (AACE/ACE/AME, ACR, ATA, European, Korean) were compared to decision making based solely on echogenicity, for indicating FNA in 110 nodules with a diameter of ≥10 mm.
Results: In nodules >20 mm, the sensitivities of the 5 TIRADS were significantly higher (from 92.9 to 100%) than the solely echogenicity-based decision (77.8%, P < 0.05). In nodules 10 to 20 mm, the sensitivities and specificities of the TIRADS’ in identifying malignant nodules ranged between 80.5% and 91.0%, and between 31.4 and 50.9%, respectively. Had FNA been suggested in all hypoechoic nodules irrespective of other ultrasound characteristics, comparable sensitivity and specificity, 87.2% and 43.4%, respectively, were obtained. Compared to nodules >20 mm, a higher proportion of cancers were hypoechoic in the 10 to 20 mm size range (87.2% vs. 77.8%, P = 0.04). In those 10 to 20 mm, significantly lower proportion of isoechoic than hypoechoic nodules showed suspicious findings (30.0% vs. 70.7%, P = 0.008).
Conclusion: In nodules 10 to 20 mm, in contrast to larger nodules, the decision to offer FNA may rely on a single US feature, echogenicity. Using well-defined criteria for thyroid nodule descriptors, based on a lexicon, our data need to be challenged and confirmed in large-scale studies before accepting a simplified RSS for thyroid nodules in the 10 to 20 mm range.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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