Avrupa tiroid görüntüleme raporlama ve veri sistemi (EU-TIRADS) kullanılarak benign ve malign tiroid nodüllerinin ayırımı.

Amaç: Tiroid nodüllerinde malignite riskini tahmin etmek esastır. Bu amaçla, TIRADS sınıflandırma sistemi malignite riskini değerlendirmek ve tedavi stratejisini planlamak için kullanılabilir. Bu çalışmanın amacı, EU-TIRADS sınıflamasının klinik uygulanabilirliğini ve güvenilirliğini değerlendirmektir. Gereç ve Yöntem: Bu retrospektif çalışmaya Mayıs 2013 ile Mayıs 2016 tarihleri arasında ultrason eşliğinde tiroid İİAB yapılan 156 hasta dahil edildi. Ultrason görüntüleri incelendi ve ultrason rehberliğinde İİAB sonuçları elde olundu. EU-TIRADS sistemi kullanılarak her bir nodül, ultrason özelliklerine göre TIRADS 1 ile 5 arasında sınıflandırılmıştır. Bulgular: Yüz doksan altı nodüle İİAB yapıldı. Yirmi yedi (%14) nodül histopatolojik olarak malign teşhis edildi. TIRADS 2, 3, 4 ve 5 malignite riski sırasıyla %0 ,%2,2, %5,1, %59,5 idi. TIRADS 2, 3 ve 4'ün muhtemel benign ve TIRADS 5'in muhtemel malign olduğu düşünüldüğünde; duyarlılık, özgüllük, pozitif prediktif değer ve negatif prediktif değer, sırasıyla 0,82, 0,91, 0,60 ve 0,97 bulundu. Ultrasonun genel tanısal doğruluğu 0,90 olarak belirlenmiştir. Sonuç: EU-TIRADS uygulaması kolay bir yöntemdir ve tiroid nodüllerinin malignite riskini tahmin etmede güvenilirdir.

Anahtar Kelimeler:

TIRADS, ince iğne aspirasyon biyopsisi, tiroid nodülü, ultrasonografi

Differentiation of benign thyroid nodules from malignant ones using European thyroid imaging reporting and data system (EU-TIRADS)

Conclusion: EU-TIRADS is an easy tool to apply and it is reliable in prediction of malignancy risk of thyroid nodules.Results: FNAB was performed in 196 nodules. Twenty-seven (14%) nodules were histopathologically diagnosed as malignant. The risk of malignancy of TIRADS 2, 3, 4, and 5 was 0%, 2.2%, 5.1%, 59,5%, respectively. Considering TIRADS 2, 3, and 4 as probable benign and TIRADS 5 as probable malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were found to be as 0.82, 0.91, 0.60, and 0.97, respectively. The overall accuracy of ultrasound was determined as 0.90.Materials and methods: In all, 156 patients who underwent ultrasound-guided FNAB of thyroid between May 2013 and May 2016 were included in this retrospective study. Ultrasound images were reviewed, and ultrasound-guided FNAB results were obtained. With the use of EU-TIRADS classification, each nodule was categorized as TIRADS from 1 to 5 according to its ultrasound features.Purpose: It is essential to predict the malignancy risk in thyroid nodules. For this purpose, thyroid imaging reporting and data system (TIRADS) classification system can be used to evaluate malignancy risk and plan the treatment strategy. The aim of this study is to evaluate the clinical feasibility and reliability of European-TIRADS (EU-TIRADS) classification.

Keywords:

TIRADS, fine needle aspiration biopsy, thyroid nodule, ultrasound,

PDF

___

1. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Arch Intern Med 1994;154:1338-1340.
2. Perros P. British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer. 2nd ed. London: Royal College of Physicians; 2007;5-11.
3. Sampson RJ, Woolner LB, Bahn RC, Kurland LT. Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer 1974;34:2072-2076.
4. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008;22:901-911.
5. Frates MC, Benson CB, Charboneau JW, et al. Society of Radiologists in Ultrasound. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794-800.
6. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-1771.
7. Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyroid 2005;15:708-717.
8. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 1994;69:44-49.
9. Griffin JE. Management of thyroid nodules. Am J Med Sci 1988;296:336-347.
10. Hawkins F, Bellido D, Bernal C, et al. Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease. Cancer 1987;59:1206-1209.
11. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color Doppler features. J Clin Endocrinol Metab 2002;87:1941-1946.
12. 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;94:1748-1751.
13. Park JY, Lee HJ, Jang HW, et al. A roposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid 2009;19:1257-1264.
14. Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 2013;168:649-655.
15. Kim KM, Park JB, Kang SJ, Bae KS. Ultrasonographic guideline for thyroid nodules cytology: single institute experience. J Korean Surg Soc 2013;84:73-79.
16. Koike E, Noguchi S, Yamashita H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001;136:334-337.
17. Russ G, Bigorgne C, Royer B, Rouxel A, Bien-Perrard W. The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid. J Radiol 2011; 92: 701-713.
18. Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-691.
19. Hong YJ, Son EJ, Kim EK, Kwak JY, Hong SW, Chang HS. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging 2010;34:127-133.
20. Kwak JY, Jung I, Baek JH, et al. Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study. Korean J Radiol 2013;14:110-117.
21. Moon HJ, Kim EK, Kwak JY. Malignancy risk stratification in thyroid nodules with benign results on cytology: combination of thyroid imaging reporting and data system and bethesda system. Ann Surg Oncol 2014;21:1898-1903.
22. Ko SY, Lee HS, Kim EK, Kwak JY. Application of the Thyroid Imaging Reporting and Data System in thyroid ultrasonography interpretation by less experienced physicians. Ultrasonography 2014;33:49-57.
23. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB. Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med 2003;22:1083-1090.
24. American College of Radiology, “Breast imaging reporting and data system. Breast imaging atlas”. 4th edition. Reston: American College of Radiology; 2003;1-86.
25. 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;26:1–133.
26. Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean society of thyroid radiology consensus statement and recommendations. Korean J Radiol 2016;17:370–395.
27. Gharib H, Papini E, Garber JR, et al. AACE/ACE/AME Task Force on Thyroid Nodules: American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract 2016;22:622–639.
28. Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS: description and reflections. Ultrasonography 2016;35:25–38.
29. Russ G, Bonnema SJ, Erdogan MF, et al. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J 2017;6:225-237.
30. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009;19:1159-1165.