Objectives: Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, cost-effective and is a mandatory step in the workup of thyroid nodules. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Specific US features suggestive of malignancy have been recognized and described in literature, namely hypoechogenicity, irregular or blurred margins, microcalcifications, taller than wider shape and vascular signals. These features have been included in different US classifications developed over the years by many scientific societies: the American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Associazione Medici Endocrinologi (AME), Korean Society of Thyroid Radiology, American College of Radiology and European Thyroid Association who built the European Thyroid Imaging and Reporting Data System, called EU-TIRADS. Therefore, these societies set up guidelines about indications for FNA.
Methods: We aimed to estimate and compare the performance and the limits of the different US classifications in discriminating nodules for malignancy. We compared the indications for FNA among the different US scoring systems. The non indication for FNA and the relevance of repeated FNA were also discussed.
Results: Despite some differences between the US scoring systems, we observed that all the US classifications provide an effective malignancy risk stratification for thyroid nodules, demonstrated the ability of these schemes in selecting nodules for FNA. It is time to figure out a unique international TIRADS system that will gather the strengths of the different US scoring systems and refine the indications of FNA in thyroid nodules.
18 - 21 May 2019
European Society of Endocrinology