Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the “Right” TIRADS

摘要: Context The prevalence of thyroid nodules in the general population is increasingly high, and at least half those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as "rule-out" tests that can identify do not require fine-needle aspiration (FNA) cytology. Objective To comparatively assess performances five internationally endorsed sonographic classification [those American Thyroid Association, Association Clinical Endocrinologists, College Radiology (ACR), European Korean Society Radiology] identifying whose FNAs safely deferred estimate their negative predictive values (NPVs). Design Prospective study referred for FNA. Setting Single academic referral center. Patients Four hundred seventy-seven patients (358 females, 75.2%); mean (SD) age, 55.9 (13.9) years. Main outcome measures Number biopsies classified unnecessary, false-negative rate (FNR), sensitivity, specificity, values, diagnostic ORs each system. Results Application systems' FNA criteria would have reduced number performed by 17.1% 53.4%. ACR Imaging Reporting Data System (TIRADS) allowed largest reduction (268 502) with lowest FNR (NPV, 97.8%; 95% CI, 95.2% 99.2%). Except TIRADS, all other exhibited significant discriminatory performance but produced significantly smaller reductions procedures. Conclusions Internationally risk stratification vary widely ability reduce unnecessary nodule FNAs. TIRADS outperformed others, classifying more than a 2.2%.