Abstract
Thyroid lesions often cause unnecessary patient anxiety and lead to financial burden on patients who undergo invasive tests for clinically unimportant lesions.USG with Doppler interrogation is a noninvasive method of selecting the most suspicious lesion (on the basis of USG features) by avoiding needless biopsies for every nodule . The study aims at assessing the role of USG and Color Doppler in the risk stratification of thyroid lesions based on standard lexicon: ACR-TIRADS 2017 and correlating findings with histopathological examination. Secondly, guiding decision whether to perform FNAC/biopsy or follow up by interval USG. Thirdly, in improving prognosis and survival rate by detecting malignancy at an early stage. 125 adult patients with thyroid lesions were evaluated from March 2018 to August 2019 with ultrasonography and color Doppler and categorized as per ACR-TIRADS 2017 classification. The results in each TIRADS category were compared with histopathological examination. Combining TIRADS 2 and 3 as probably benign ultrasound findings and TIRADS 4 and 5 as probably malignant , sensitivity, specificity, positive predictive value , negative predictive value and accuracy were 96.8%, 63.9%, 73.8%, 95.0% and 80.8% respectively for TIRADS classification when compared with the cytohistopathological results. Doppler findings of intranodular /central/ central > peripheral pattern of vascularity favouring malignancy correlated well with histopathological results. Thus, USG can be used as a reliable modality for early detection of thyroid lesions and in excluding malignancy thereby obviating costly interventions for nodules that can be safely followed up by interval USG.
Keywords: USG, Thyroid lesions, Color Doppler, ACR TIRADS 2017, FNAC, Histopathological.
References
- Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: a 5-year follow-up. 2000 Jun;215 (3):801-6. doi: 10.1148/radiology.215.3.r00jn07801.
- Russ G, Leboulleux S, Leenhardt L, Hegedüs L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J. 2014 Sep;3(3):154-63. doi: 10.1159/000365289.
- Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. 2011 Sep;260(3):892-9. doi: 10.1148/radiol.11110206.
- Wettasinghe MC, Rosairo S, Ratnatunga N, Wickramasinghe ND. Diagnostic accuracy of ultrasound characteristics in the identification of malignant thyroid nodules. BMC Res Notes. 2019 Apr 2;12(1):193. doi: 10.1186/s13104-019-4235-y.
- Woliński K, Szkudlarek M, Szczepanek-Parulska E, Ruchała M. Usefulness of different ultrasound features of malignancy in predicting the type of thyroid lesions: a meta-analysis of prospective studies. Pol Arch Med Wewn. 2014;124(3):97-104. doi: 10.20452/pamw.2132.
- Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: how useful and accurate is it?. Indian J Cancer. 2010 Oct-Dec;47(4):437-42. doi: 10.4103/0019-509X.73564.
- Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results?. Br J Radiol. 2013 May;86 (1025): 20130007. doi: 10.1259/bjr.20130007.
- Samir AE, Vij A, Seale MK, Desai G, Halpern E, Faquin WC, Parangi S, Hahn PF, Daniels GH. Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. 2012 May;22(5):461-7. doi: 10.1089/thy.2011.0061.
- Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017 May;14(5):587-595. doi: 10.1016/j.jacr.2017.01.046.
- Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015 Dec;12(12 Pt A):1272-9. doi: 10.1016/j.jacr.2015.07.011.
- Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy?. Radiology. 2010 Apr;255(1):260-9. doi: 10.1148/radiol.09091284.
- Chammas MC, Gerhard R, de Oliveira IR, Widman A, de Barros N, Durazzo M, Ferraz A, Cerri GG. Thyroid nodules: evaluation with power Doppler and duplex Doppler ultrasound. Otolaryngol Head Neck Surg. 2005 Jun;132(6):874-82. doi: 10.1016/j.otohns.2005.02.003
- Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009 May;94(5):1748-51. doi: 10.1210/jc.2008-1724.
- Moifo B, Takoeta E, Tambe J, Blanc F, Fotsin J. Reliability of Thyroid Imaging Reporting and Data System (TIRADS) Classification in Differentiating Benign from Malignant Thyroid Nodules. Open Journal of Radiology. 2013;03(03):103-107.
- 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. European Journal of Endocrinology. 2013;168(5):649-655.
Corresponding Author
Dr Sana Afsar
Address: Lake Side, Old Commissioner’s Compound, Near Brojendra Palace, Ranchi 834001, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.72
