BACKGROUND: Ultrasonography patterns and molecular testing may assist in stratifying the malignancy risk of indeterminate cytology diagnosis. The purpose of this study was to assess the value of fine needle aspiration (FNA) cytology in combination with American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and mutation in differentiating high-risk thyroid nodules.
METHODS: From February 2010 to February 2014, 2,643 consecutive thyroid nodules from 2,399 patients (688 men and 1,711 women; mean age, 44.3±12.5 years) who underwent preoperative FNA biopsies were enrolled. The Jiangsu Institute of Nuclear Medicine has adopted TI-RADS stratification and mutation analysis as a routine procedure to assist in evaluating FNA cytopathology since January 2016. From February 2017 to July 2018, 1,905 thyroid nodules of 1,837 patients (501 men and 1,336 women, 49.5±12.8 years) who underwent preoperative ultrasound-guided FNA biopsies with mutation analysis and ACR TI-RADS grading data available were enrolled for comparison in this study.
RESULTS: The cancer risk in nodules with mutation was 99.7% (905/908) according to the histological findings. The risk of malignancy (ROM) was found to increase with advancing ACR TI-RADS category. High-risk ultrasound features (TI-RADS 5) did show a good performance in predicting malignancy (98.1%). The combination of TI-RADS 5 and mutation reached the best diagnostic efficiency [sensitivity 97.7%, specificity 94.8%, positive predictive value (PPV) 99.6%]. It is apparent that after the implementation of ACR TI-RADS and the mutation analysis, the resection rates (RRs) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) I and III categories showed significant decreases (39.1% 21.6% and 36.1% 16.7%, respectively). In contrast, the risks of malignancy of TBSRTC I and III categories indicated substantial increases (41.5% 80.0% and 34.6% 50.0%, respectively). The ROM of thyroid nodules with nondiagnostic (ND, I) category showed the most significant increase of 41.5% to 80.0%.
CONCLUSIONS: ACR TI-RADS, together with mutation and cytological diagnoses, can assist in improving the prediction of malignancy of thyroid nodules, especially in the TBSRTC I and III categories.
