Abstract
Summary. Given the increase in the incidence of differentiated thyroid cancer in Ukraine, the issue of early diagnosis and treatment of thyroid carcinomas remains extremely relevant. The accuracy of early diagnosis of carcinomas using ultrasound examination and cytological examination can improve the quality of life in this patient cohort. Therefore, it is important to compare ultrasound features according to the classification of the Thyroid Imaging Reporting And Data System (TIRADS) with the Bethesda System for Reporting Thyroid Cytology (BSRTC) and data from histological examination of patients with benign and malignant focal thyroid pathology to improve the accuracy of preoperative tumor diagnosis.
The aim was to study the correlation of TIRADS, BSRTC and histological examination data in focal thyroid pathology.
Material and methods. Ultrasound data of 465 patients diagnosed with thyroid nodular pathology were analyzed in comparison with cytological examination data obtained as a result of fine needle aspiration biopsy (FNAB), as well as with pathological histological examination data after surgery.
Results. In the group of patients with a pathologically verified diagnosis of papillary carcinoma of the thyroid according to ultrasound data before surgery, 93% of cases were classified as TIRADS 4 and 5; 5.7% of cases - TIRADS 3 and 1.3% of cases - TIRADS 2. According to cytological examination data in this group of patients, 99.7% of cases were classified as BSRTC VI, V, and 0.3% of cases – as BSRTC IV. In the group of patients with a pathohistologically verified diagnosis of benign thyroid pathology, 38.8% of cases of TIRADS 2, 50.2% of cases of TIRADS 3, as well as 10.3% of cases of TIRADS 4 and 0.7% of TIRADS 5 were identified according to ultrasound data. Cytological examination revealed 84.2% of BSRTC II cases, 7.3% of BSRTC III cases, 6.7% of BSRTC IV cases, and 1.8% of BSRTC V cases. TIRADS 3 showed the greatest diversity in BSRTC interpretation and pathohistological findings. The majority of patients with formations classified as TIRADS 3 are perimenopausal women.
Conclusions. In the case of thyroid ultrasound, the correlation of TIRADS with BSRTC and histological examination data increases with small sizes of the formation (up to 15 mm), and decreases with large sizes of formation (more than 30 mm). A multidisciplinary and clinical approach to the diagnosis of thyroid formations allows the clinician, in cooperation with the diagnostician and cytologist, to properly determine the need for further surgical treatment for the patient, and in case of low risk, to carry out dynamic observation. Patients with formations classified as TIRADS 3, 4, 5 should be recommended FNAB of the thyroid gland regardless of the size of the formation. Women in the perimenopausal period need more careful monitoring to control the volume and structure of thyroid formations. Adequate and timely diagnosis of malignant thyroid lesions
allows choosing the correct tactics and volume of surgical treatment, which prevents the recurrence of neoplasms.
References
Horvath E, Silva CF, Majlis S, Rodriguez I, Skoknic V, Castro A, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol. 2017 Jun;27(6):2619-28. doi: 10.1007/s00330-016-4605-y.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Mandifferentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.
Singaporewalla RM, Hwee J, Lang TU, Desai V. Clinico-pathological correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World J Surg. 2017 Jul;41(7):1807-11. doi: 10.1007/s00268-017-3919-5.
Periakaruppan G, Seshadri KG, Vignesh Krishna GM, Mandava R, Sai VPM, Rajendiran S. Correlation between ultrasound-based TIRADS and Bethesda system for reporting thyroid-cytopathology: 2-year experience at a Tertiary Care Center in India. Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):651-5. doi: 10.4103/ijem. IJEM_27_18.
Li F, Pan D, Wu Y, Peng J, Li Q, Gui X, et al. Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule. Diagn Cytopathol. 2019 Sep;47(9):881-9. doi: 10.1002/dc.24248.
Liang XW, Cai YY, Yu JS, Liao JY, Chen ZY. Update on thyroid ultrasound: a narrative review from diagnostic criteria to artificial intelligence techniques. Chin Med J (Engl). 2019 Aug 20;132(16):1974-82. doi: 10.1097/CM9.0000000000000346.
Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines. Radiology. 2016 Mar;278(3):917-24. doi: 10.1148/radiol.2015150056.
Olson E, Wintheiser G, Wolfe KM, Droessler J, Silberstein PT. Epidemiology of Thyroid Cancer: A Review of the National Cancer Database, 2000-2013. Cureus. 2019 Feb 24;11(2):e4127. doi: 10.7759/cureus.4127.
Jiang H, Tian Y, Yan W, Kong Y, Wang H, Wang A, et al. The Prevalence of thyroid nodules and an analysis of related lifestyle factors in Beijing Communities. Int J Environ Res Public Health. 2016 Apr 22;13(4):442. doi: 10.3390/ijerph13040442.
Dauksiene D, Petkeviciene J, Klumbiene J, Verkauskiene R, Vainikonyte-Kristapone J, Seibokaite A, et al. Factors associated with the prevalence of thyroid nodules and goiter in middle-aged euthyroid subjects. Int J Endocrinol. 2017;2017:8401518. doi: 10.1155/2017/8401518.