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Context: Ultrasound-based risk stratification systems (Thyroid Imaging Reporting and Data Systems (TIRADSs)) of thyroid nodules (TNs) have been implemented in clinical practice worldwide based on their high performance. However, it remains unexplored whether different TIRADSs perform uniformly across a range of TNs in routine practice. This issue is highly relevant today, given the ongoing international effort to establish a unified TIRADS (i.e. I-TIRADS), supported by the leading societies specializing in TNs. The study aimed to conduct a direct comparison among ACR-, EU-, and K-TIRADS in the distribution of TNs: (1) across the TIRADS categories, and (2) based on their estimated cancer risk., Methods: A search was conducted on PubMed and Embase until June 2023. Original studies that sequentially assessed TNs using TIRADSs, regardless of FNAC indication, were selected. General study characteristics and data on the distribution of TNs across TIRADSs were extracted., Results: Seven studies, reporting a total of 41,332 TNs, were included in the analysis. The prevalence of ACR-TIRADS 1-2 was significantly higher than that of EU-TIRADS 2 and K-TIRADS 2, with no significant difference observed among intermediate- and high-risk categories of TIRADSs. According to malignancy risk estimation, K-TIRADS often classified TNs as having more severe risk, ACR-TIRADS as having moderate risk, and EU-TIRADS classified TNs as having lower risk., Conclusion: ACR-, EU-, and K-TIRADS assess TNs similarly across their categories, with slight differences in low-risk classifications. Despite this, focusing on cancer risk estimation, the three TIRADSs assess TNs differently. These findings should be considered as a prerequisite for developing the I-TIRADS.

Background and Objectives : The aim of the study was to evaluate the predictive value of the ultrasound criterion "non-marked hypoechogenicity" for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M-TIRADS score. Materials and Methods : A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound-guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M-TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller-than-wide shape, metastatic lymph nodes). Non-marked hypoechoic nodules were classified as TIRADS 3. Results : Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub-cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M-TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR-18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M-TIRADS and Kwak systems-0.9 vs. 0.8, respectively). Accuracy of M-TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. Conclusions : The non-marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M-TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.

Objective: Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published., Design: We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions., Methods: Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data., Results: Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0-1.3), 5.9% (95% CI: 2.6-9.2), 21.4% (95% CI: 11.1-31.7), and 76.1% (95% CI: 63.7-88.5). Sensitivity, specificity, PPV, NPV, LR+, LR- and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5-89.8), 84.3% (95% CI: 66.2-93.7), 76.1% (95% CI: 63.7-88.5), 85.4% (95% CI: 79.1-91.8), 4.9 (95% CI: 2.9-8.2), 0.2 (95% CI: 0.1-0.3), and 24.5 (95% CI: 11.7-51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5., Conclusions: A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.

Background: The present study was undertaken to systematically review the literature on the reliability of using contrast-enhanced ultrasound (CEUS) to assess thyroid nodules. To avoid the potential bias in studies using a cytological standard of reference, here we aimed to meta-analyze data from studies adopting histological diagnosis as the gold standard., Methods: A comprehensive literature exploration of PubMed and Scopus was conducted. The search was updated until June 2018 and references of the retrieved articles screened. Only original articles reporting the histological follow-up of nodules previously undergone CEUS evaluation were eligible for inclusion. Pooled sensitivity, specificity, PPV, and NPV of CEUS were calculated by DerSimonian and Laird method (random-effects model)., Results: The literature search retrieved 1885 articles, and 14 were included for the study. There were Chinese, Italian, German, and Austrian authors. All studies used SonoVue. The overall number of reported nodules was 1515, of which 775 were classified as positive at CEUS and 740 as negative. Pooled sensitivity, specificity, PPV, and NPV of CEUS were 85% (95% CI 83-88), 82% (95% CI 77-87), 83% (95% CI 77-88), and 85% (95% CI 81-88), respectively. Moderate inconsistency was present for specificity and PPV. There was publication bias for sensitivity and NPV., Conclusions: CEUS reaches good performance in discriminating between malignant and benign thyroid lesions.

Purpose:  To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules., Materials and Methods:  In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods., Results:  TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE., Conclusion:  Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity., Competing Interests: Cantisani received honoraria for lectures from Bracco, Samsung and Canon.Dietrich CFD received honoraria: Hitachi, Siemens, Supersonic, Mindray, GE, Bracco.Radzina received honoraria for lectures from Canon and Bracco., (© Georg Thieme Verlag KG Stuttgart · New York.)

The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland., (Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.)

Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Simple Summary: This study is aimed at raising the question of the use of several TIRADS systems that stratify the risk of thyroid nodule malignancy. Approximately 5–20% of thyroid nodules are malignant, but most nodules are benign, and they are scored by FNA biopsy. One of the goals is to reduce the number of unnecessary FNA and the associated with-it possible complications for the patient and financial cost. Most TIRADS systems are based on the fact that one suspicious feature of a thyroid nodule classifies it as malignant, but there is a modified Kwak et al. system that is based on the count of malignant features. Therefore, this study is intended to estimate the specificity, sensitivity, and accuracy of the systems and, in the future, think about reducing the number of FNA biopsies. The result of this study can be important for all doctors who face thyroid changes, such as radiologists, ultrasonography specialists, and endocrinologists, those who must decide about the need for an FNA. Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity. [ABSTRACT FROM AUTHOR]

Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting. [ABSTRACT FROM AUTHOR]