Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules-Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

Katarzyna Dobruch-Sobczak; Zbigniew Adamczewski; Ewelina Szczepanek-Parulska; Bartosz Migda; Kosma Woliński; Agnieszka Krauze; Piotr Prostko; Marek Ruchała; Andrzej Lewiński; Wiesław Jakubowski; Marek Dedecjus

doi:10.3390/jcm8111781

Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules-Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

J Clin Med. 2019 Oct 25;8(11):1781. doi: 10.3390/jcm8111781.

Authors

Affiliations

¹ Radiology Department II, Maria Sklodowska-Curie Institute- Oncology Center, 15 Wawelska St., 02-034 Warsaw, Poland.
² Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 4 Kosciuszki St., 90-419 Lodz, Poland.
³ Department of Endocrinology and Metabolic Diseases, Research Institute, Polish Mother's Memorial Hospital - Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland.
⁴ Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland.
⁵ Department of Imaging Diagnostics, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland.
⁶ Statistician, 00-001 Warsaw, Poland.
⁷ Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie Institute- Oncology Center, 15 Wawelska St., 02-034 Warsaw, Poland.

Abstract

Background: To validate the European Thyroid Imaging and Reporting Data System EU-TIRADS classification in a multi-institutional database of thyroid nodules by analyzing the obtained scores and histopathology results.

Methods: A total of 842 thyroid lesions (613 benign, 229 malignant) were identified in 428 patients (mean age 62.7 years) and scored according to EU-TIRADS, using ultrasound examination. In all tumors, histopathological verification was performed.

Results: In EU-TIRADS 2 (154 nodules) all nodules were benign; in EU-TIRADS 3, only 3/93 malignancies were identified. In EU-TIRADS 4, 12/103 were malignant, and in EU-TIRADS 5 (278 benign vs. 214 malignant). The malignant nodules that would not have qualified for biopsy were: EU-TIRADS 3, 2/3 (67%) malignancies were <20 mm, in EU-TIRADS 4, 7/12 (58%) were <15 mm. In EU-TIRADS 5, 72/214 (34%) were <10 mm; in total, 81/229 (36%) malignant lesions would have been missed. The cutoff between EU-TIRADS 3/4 had sensitivity of 100%, specificity of 25.1%. Using cutoff for EU-TIRADS 5, 93.4%, 54.6%, respectively.

Conclusion: The application of EU-TIRADS guidelines allowed us to achieve moderate specificity. The vast majority of malignancies in EU-TIRADS 3, 4, and 5 would not have been recommended for biopsy because having a smaller size than that proposed classification.

Keywords: EU-TIRADS classification; histopathological verification; thyroid nodules; ultrasound.