FNA indication according to ACR-TIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18 F-FDG PET/CT,Journal of Endocrinological Investigation

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FNA indication according to ACR-TIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18 F-FDG PET/CT
Journal of Endocrinological Investigation ( IF 3.9 ) Pub Date : 2020-04-08 , DOI: 10.1007/s40618-020-01244-2
P Trimboli _{1,

2} , L Knappe ₁ , G Treglia _{1,

3,

4} , T Ruberto ₁ , A Piccardo ₅ , L Ceriani ₁ , G Paone ₁ , L Giovanella _{1,

6}

Affiliation

Objective

Focal thyroid incidentaloma (TI) occurs in a 2% of ¹⁸F-FDG PET/CT and about one-third of TIs is cancer. Due to the lack of evidence on the optimal management of TI, current guidelines suggest performing fine-needle aspiration cytology (FNA). The study aim was to evaluate the reliability of ACR-TIRADS, EU-TIRADS, and K-TIRADS in indicating FNA in TIs.

Design

We retrospectively reviewed ¹⁸F-FDG PET/CT TIs recorded during the period 2016–2019. Enrolled were TIs with histologic outcome and autonomous nodules. Cases with uncertain matching between ¹⁸F-FDG PET/CT, US/scintiscan and histology were excluded.

Results

Eighty TIs at ¹⁸F-FDG PET/CT (median size 17 mm, median SUVmax 7.85) were included; a 26.2% was cancer. The percentage of nodules classified as high risk according to ACR-TIRADS, EU-TIRADS, and K-TIRADS was 20%, 30%, and 29.8%, respectively. The cancer prevalence in high-risk class was 56.2%, 66.7%, and 65.2% in ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively. ACR-TIRADS had the lowest number of cases with FNA indication (48%) and the K-TIRADS, the highest one (75%). Evaluating the reliability of the three systems in indicating FNA, we found a 100% sensitivity and NPV for EU-TIRADS and K-TIRADS; while all the three systems showed poor specificity and PPV.

Conclusion

All TIRADSs were reliable to stratify the risk of cancer in focal TI. Comparing their reliability in indicating FNA, we found a good performance of EU-TIRADS and K-TIRADS. Considering the high cancer percentage expected in this setting of patients, those TIRADS with higher propensity to indicate FNA should be preferred.

中文翻译：

在18 F-FDG PET / CT时根据ACR-TIRADS，EU-TIRADS和K-TIRADS在甲状腺偶发瘤中的FNA指征

目的

局灶性甲状腺偶发瘤（TI）发生在¹⁸ F-FDG PET / CT中的2％，大约三分之一的TI是癌症。由于缺乏有关TI最佳治疗的证据，目前的指南建议进行细针穿刺细胞学检查（FNA）。研究目的是评估ACR-TIRADS，EU-TIRADS和K-TIRADS在指示TI中FNA方面的可靠性。

设计

我们回顾性审查了2016-2019年期间记录的^18个F-FDG PET / CT TI。登记的是具有组织学结果和自主结节的TI。¹⁸ F-FDG PET / CT，US / scintiscan和组织学之间不确定匹配的病例被排除在外。

结果

包括80个¹⁸ F-FDG PET / CT的TI （中位尺寸17 mm，中位SUVmax 7.85）；26.2％是癌症。根据ACR-TIRADS，EU-TIRADS和K-TIRADS归类为高危结核的比例分别为20％，30％和29.8％。在ACR-TIRADS，EU-TIRADS和K-TIRADS中，高危人群的癌症患病率分别为56.2％，66.7％和65.2％。ACR-TIRADS的FNA征兆最少（48％），而K-TIRADS的最高（75％）。通过评估这三个系统在指示FNA方面的可靠性，我们发现EU-TIRADS和K-TIRADS的灵敏度和NPV为100％；而这三个系统均显示出较差的特异性和PPV。