Affiliation:
1. FHC, Kollam, Kerala, India
2. Department of General Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
Abstract
Abstract
Introduction:
Thyroid ultrasound (US) should be performed in the initial assessment of the gland. The fine-needle aspiration cytology (FNAC) is an inexpensive and useful tool for detecting thyroid cancer. In the management of thyroid nodule patients, recommending who should be submitted to FNAC is still controversial.
Aim:
The aim of the study was to evaluate whether the US-based Thyroid Imaging Reporting and Data System (TI-RADS) scoring system is reliable in differentiating between benign and malignant thyroid nodules when compared to FNAC and its practical application in clinical decision-making.
Materials and Methods:
A total of 59 patients having solitary thyroid nodules were studied over 20 months. Thyroid function tests, US and FNAC of the thyroid were done. Using US, the thyroid nodule was evaluated for five sonological features: internal composition, echogenicity, margins, presence and type of calcification and shape of the lesion. The nature of the lesion was assessed based on the TI-RADS score calculated from the five US parameters. This result, along with FNAC, which was reported using The Bethesda System for Reporting Thyroid Cytopathology was finally compared with the histopathology reports.
Results:
When the suspicious sonological features were evaluated, the presence of solid components and taller-than-wide shapes was found to be maximum sensitive but less specific. Specificity, positive predictive value and negative predictive value were found to be maximum for the presence of microcalcification and presence of hypoechogenicity. The sensitivity of TI-RADS to detect malignancy was higher (100%) than FNAC (66.7%). The specificity of TI-RADS to detect malignancy was lower (36.2%) as compared to FNAC.
Conclusion:
TI-RADS can be used to avoid unnecessary fine-needle aspirations. It helps in decreasing confusion and assists in deciding when FNAC should be performed. TI-RADS is cost-effective and has a vital role in the initial evaluation and investigation of patients presenting with solitary nodules of the thyroid. Moreover, it is simple to use, reliable and easily reproducible.