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. 2021 Sep 4;13(17):4467.
doi: 10.3390/cancers13174467.

Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial

Philipp Seifert  1 , Simone Schenke  2 , Michael Zimny  3 , Alexander Stahl  4 , Michael Grunert  5 , Burkhard Klemenz  5 , Martin Freesmeyer  1 , Michael C Kreissl  2 , Ken Herrmann  6 , Rainer Görges  6   7
Affiliations

Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial

Philipp Seifert et al. Cancers (Basel). .

Abstract

Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30% of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency.

Keywords: cancer; nodule; non-autonomously functioning; risk of malignancy (ROM); scintigraphy; thyroid; thyroid imaging reporting and data systems (TIRADS); ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Examples of thyroid nodules (TNs) that could not be classified according to American Thyroid Association (ATA) Guidelines. (A1) (transversal)/(A2) (sagittal): Solid isoechoic papillary thyroid carcinoma (PTC) with irregular margins (A2, white triangle markers). (B1) (transversal)/(B2) (sagittal): Mainly solid isoechoic benign (Bethesda II) thyroid nodule (TN) with taller-than-wide (TTW) shape.
Figure 2
Figure 2
Performance of the risk stratification systems (RSSs). Abbreviations: TNs—Thyroid Nodules; ACR—American College of Radiology; EU—European Union; ATA—American Thyroid Association; RSS—Risk Stratification System.
Figure 3
Figure 3
Receiver Operating Curves (ROCs) of the risk stratification systems (RSSs) *. * Thyroid nodules (TNs) that were not classifiable (N/A) are not included.
See this image and copyright information in PMC

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