Retrospective analysis of the ultrasound features of resected thyroid nodules
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ORIGINAL ARTICLE
Retrospective analysis of the ultrasound features of resected thyroid nodules Loredana Pagano1 Enrico Costantino Falco2 Alessandro Bisceglia1 Alessandro Gambella2 Ruth Rossetto1 Sara Garberoglio1 Francesca Maletta2 Donatella Pacchioni2 Roberto Garberoglio1 Ezio Ghigo1 Mauro Giulio Papotti2,3 ●
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Received: 8 May 2020 / Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Several ultrasound (US) risk stratification systems (US-RSSs) have been proposed to stratify the risk of malignancy (ROM) of thyroid nodules. This risk might be overestimated due to selection bias and comparison with the cytological report alone. Our study aimed to compare ROM and diagnostic performance of three guidelines (ATA, AACE/ACE/AME, EUTIRADS) and evaluate the changes in unnecessary biopsy according to the nodule size cutoff for biopsy, using histology as gold standard. Methods This retrospective observational study included 146 consecutive patients who underwent surgery after US and cytological characterization. We analyzed the effectiveness and accuracy of three US-RSSs. Results 46.6% of nodules were diagnosed as malignant. Applying US-RSS, the percentage of nodules that should have been analyzed by biopsy was 84.25% with ATA, 69.86% with EUTIRADS and 64.38% with AACE/ACE/AME systems. The ROM was 94.9%, 86.0%, 87.0% for high-risk category, 36.4%, 32.0%, 35.4% for intermediate-risk category and 22.9%, 0.0%, 22.9% for low-risk category by ATA, AACE/ACE/AME and EUTIRADS systems, respectively. EUTIRADS and AACE/ACE/AME systems were more accurate in differentiating malignant from benign cases. ATA score was the more sensitive US-RSS to identify malignant tumors within the high-risk category. About the unnecessary biopsies, in the intermediate-risk category, the application of the size criterion helps to increase specificity in all systems. Conclusions The US categorization of low and high-risk thyroid nodules using current US-RSSs helps alone to determine the optimal treatment option. Nodule size remains relevant to recommend biopsy for the intermediate-risk category. Keywords Thyroid nodules Ultrasound risk stratification Cytology aspiration Histology Diagnosis ●
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Introduction Thyroid nodules are common gland abnormalities that can be found in up to 65% of the general population and are mostly benign and clinically silent. This high prevalence reflects a diagnostic detection bias associated with the growing use of US for the evaluation and follow-up of neck
* Ezio Ghigo [email protected] 1
Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
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Pathology Unit, City of Health and Science University Hospital, Turin, Italy
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Department of Oncology, University of Turin, Turin, Italy
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structures, including the thyroid. In the presence of an (incidental) thyroid nodule, a main objective related to its management is to identify the su
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