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. 2024 Dec 20:39:100380.
doi: 10.1016/j.jcte.2024.100380. eCollection 2025 Mar.

Can ACR TI-RADS predict the malignant risk of medullary thyroid cancer?

Ying Zhang  1   2   3   4 , Bei-Bei Ye  1   2   3   4 , Han-Xiang Wang  1   2   3   4 , Bo-Ji Liu  1   2   3   4 , Yun-Yun Liu  1   2   3   4 , Qing Wei  5 , Chuan Qin  6   7 , Yi-Feng Zhang  1   2   3   4
Affiliations

Can ACR TI-RADS predict the malignant risk of medullary thyroid cancer?

Ying Zhang et al. J Clin Transl Endocrinol. .

Abstract

Objectives: This study aimed to evaluate the diagnostic performance for medullary thyroid cancer (MTC) based on the 2017 Thyroid Imaging Reporting and Data System by the American College of Radiology (ACR TI-RADS) guideline, and the ability to recommend fine needle aspiration (FNA) for MTC.

Methods: Fifty-six MTCs were included, and 168 benign thyroid nodules (BTNs) and 168 papillary thyroid nodules (PTCs) were matched according to age. Ultrasound (US) features were reviewed according to ACR TI-RADS. US, clinical features and diagnostic performance of cytology of MTC, BTN and PTC were compared. Multivariate logistic regression analysis was performed to assess independent variables to predict MTC.

Results: Multivariate logistic regression showed that position, hypoechoic, AP/T ratio ≥ 0.9 and marked internal blood flow were independent predictors of MTC compared to BTN (P < 0.05) and nodule sizes, AP/T ratio < 1, smooth or ill-defined margin and marked internal blood flow were independent predictors of MTC compared to PTC (P < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of MTC based on ACR TI-RADS was inferior to that of PTC (0.687 vs 0.823) (P < 0.001). The recommended rate of FNA for MTC and PTC was 55.4 and 88.7 % respectively. 8 of 14 MTCs with negative FNA results (Bethesda II) had abnormal calcitonin (Ctn) results.

Conclusions: Based on the ACR TI-RADS classification, the malignant risk features of MTC were intermediate between BTN and PTC. The diagnostic efficacy of MTC and FNA recommendation rate were inferior to PTC. Ctn examination would reduce the FNA missed diagnosis of MTC.

Keywords: ACR TI-RADS; Fine needle aspiration; Medullary thyroid carcinoma; Papillary thyroid carcinoma; Ultrasound.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
The flow chart in the study (MTCs: Medullary thyroid cancers, BTNs: Benign thyroid nodules, PTCs: Papillary thyroid cancers, IHC: Immunohistochemistry).
Fig. 2
Fig. 2
Images of a 68-year-old woman with MTC. (A) Conventional US showed that the nodule with size of 24 mm was solid, hypo-echogenic, well-defined margin and wider-than-tall, which is considered as TR 4. (B) CDFI showed rich internal blood flow in the nodule.
Fig. 2
Fig. 2
Images of a 68-year-old woman with MTC. (A) Conventional US showed that the nodule with size of 24 mm was solid, hypo-echogenic, well-defined margin and wider-than-tall, which is considered as TR 4. (B) CDFI showed rich internal blood flow in the nodule.
Fig. 3
Fig. 3
Images of a 76-year-old man with PTC. (A) Conventional US showed that the nodule with size of 25 mm nodule was solid, hypo-echogenic, taller than wide and extra-thyroid extension, which is classified as TR 5. (B) CDFI did not showed blood flow in the nodule.
Fig. 3
Fig. 3
Images of a 76-year-old man with PTC. (A) Conventional US showed that the nodule with size of 25 mm nodule was solid, hypo-echogenic, taller than wide and extra-thyroid extension, which is classified as TR 5. (B) CDFI did not showed blood flow in the nodule.
Fig. 4
Fig. 4
(A) ROC curve showed the diagnostic performance for MTC based on 2017ACR TI-RADS classification and the area under the curve was 0.687. (B) ROC curve showed the diagnostic performance for PTC of 2017 ACR TI-RADS classification and the area under the curve was 0.823.
Fig. 4
Fig. 4
(A) ROC curve showed the diagnostic performance for MTC based on 2017ACR TI-RADS classification and the area under the curve was 0.687. (B) ROC curve showed the diagnostic performance for PTC of 2017 ACR TI-RADS classification and the area under the curve was 0.823.
See this image and copyright information in PMC

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