Inclusion of Thyroid Nodule Location in ACR TI-RADS Scoring: Impact on System Performance
Emerging data suggest thyroid nodule location influences malignancy risk. Researchers explored the possibility of incorporating location in the American College of Radiology Thyroid Imaging-Radiology and Data System (ACR TI-RADS) nodule assessment. They compared performance between ACR TI-RADS and revised scoring algorithms that add one or two points to higher risk locations.
The researchers tested five potential revised algorithms that add points for higher risk locations compared to current ACR TI-RADS. Four of five revised scoring algorithms that add one or two points to higher risk locations lowered accuracy due to lower specificity. However, an algorithm that adds one point to isthmus nodules did not differ significantly from ACR TI-RADS in accuracy, diagnosing one additional isthmus cancer for each 10.3 additional benign nodules recommended for biopsy.
The study was published online Jan. 20 in American Journal of Roentgenology.
Authors stated in their discussion, “Therefore, revisions that improve isthmus cancer detection may be warranted provided they do not lead to unacceptable increases in biopsies or unnecessary follow-up of benign nodules. We believe revision 1 merits further consideration because it would result in FNA of only 10.3 additional benign nodules for each additional isthmus malignancy diagnosed. Prospective studies are warranted to assess the impact of this revision on risk stratification and management systems.”
The study was a collaboration of researchers from Washington University’s Division of Endocrinology, Metabolism and Lipid Research; Mallinckrodt Institute of Radiology; and Division of Biostatistics; and University of Pennsylvania; Mayo Clinic; Brown University; Stanford University; and University of Kentucky.
Jasim S, Teefey SA, Baranski TJ, Coble DW, Langer JE, Reading CC, Beland MD, Desser TS, Szabunio MM, Middleton WD. Inclusion of Thyroid Nodule Location in ACR TI-RADS Scoring: Impact on System Performance. AJR Am J Roentgenol. 2021 Jan 20. doi: 10.2214/AJR.20.24224. Epub ahead of print. PMID: 33470836.
“This project was supported by the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH/National Center for Advancing Translational Sciences (NCATS), CTSA grant UL1TR002345.”