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Open Access 01-08-2021 | Ultrasound | Ultrasound

Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

Authors: Clotilde Sparano, Valentina Verdiani, Cinzia Pupilli, Giuliano Perigli, Benedetta Badii, Vania Vezzosi, Edoardo Mannucci, Mario Maggi, Luisa Petrone

Published in: European Radiology | Issue 8/2021

Abstract

Objective

Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS.

Methods

This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk).

Results

In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology.

Conclusions

Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management.

Key Points

• Thyroid nodule ultrasound scores do assist clinicians in real practice.

• Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis.

• The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.

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Title: Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort
Authors: Clotilde Sparano
Valentina Verdiani
Cinzia Pupilli
Giuliano Perigli
Benedetta Badii
Vania Vezzosi
Edoardo Mannucci
Mario Maggi
Luisa Petrone
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Ultrasound
Ultrasound
Thyroid Cancer
Thyroid Cancer
Thyroid Cancer
Published in: European Radiology / Issue 8/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-07703-5

At a glance: The STEP trials

Springer Medicine

Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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