The effectiveness of risk stratification systems in diagnosis of nodular thyroid disorders

Cover Page
Open Access Open Access
Restricted Access Subscription Access

Abstract


BACKGROUND: Risk stratification systems, one of the optimal solutions for differential diagnosis of nodular pituitary disorders, are currently under development. The high prevalence of pituitary diseases makes it necessary to evaluate the effectiveness of risk stratification systems and to widely implement them into routine clinical practice.

AIM: To evaluate the effectiveness of modern risk stratification systems used to diagnose nodular pituitary disorders.

MATERIAL AND METHODS: A total of 1,606 medical records of patients operated on for nodular pituitary disorders in 2006–2014 were analyzed. The preoperative ultrasonography results and cytological findings were evaluated. The ultrasonography results were classified using the TI-RADS system, while the biopsy data were classified using the TBSRTC system. The surgery protocol and the pathomorphological data were the truth criterion. The effectiveness of the TI-RADS and TBSRTC systems, as well as their contribution to the performance of endocrinologists in outpatient clinics, was analyzed.

RESULTS: Cluster analysis revealed a significant volatility of ultrasonography signs in the TI-RADS category, while there was no dominant sign that could be considered the diagnostic standard. Factor analysis proved the consistency of the imaging TI-RADS system based on individual signs. The signs being evaluated are characterized by high significance level but different priorities depending on the type of putative pathology. Discriminant analysis revealed that TI-RADS was a robust and versatile system to be used for various types of nodular pituitary disorders. The overall effectiveness of the TI-RADS system in diagnosis of pituitary tumors was low: it was characterized by 75.4% sensitivity, 84.7% specificity, and 80.1% accuracy. However, this system concretized the indications for fine-needle aspiration biopsy and drew the cytologists’ attention to the likelihood of pituitary tumor. The implementation of the TBSRTC system reduced the percentage of non-informative (by 9.8%) and controversial results (by 1.7%). Cytological examination was more effective in detection of pituitary cancer compared to ultrasonography (91.0% accuracy, 94.9% specificity, and 76.5% sensitivity). The impressions of ultrasound technicians and cytologists were concordant in 873 (54.4%) cases. A survey conducted among endocrinologists in outpatient clinics showed that implementation of the TI-RADS and TBSRTC risk stratification systems reduced the decision time (p<0.001) and errors both in diagnostics (p<0.001) and treatment approach selection (p<0.001).

CONCLUSION: The combined use of the TI-RADS and TBSRTC systems allows one to personalize the treatment approaches for patients with nodular pituitary disorders. The implementation of these systems has a positive effect on endocrinologists’ performance as it reduces the decision time and the likelihood of making errors in diagnosis and treatment strategy selection.


Yuri K. Aleksandrov

Yaroslavl States Medical University

Author for correspondence.
Email: yka2000@mail.ru
ORCID iD: 0000-0001-7581-1543
SPIN-code: 9822-2630

Russian Federation, 5, Revolutsionnaya street, Yaroslavl, 150000

MD, PhD, Professor

Elena A. Yanovskaya

Yaroslavl States Medical University

Email: lenayan2005@rambler.ru
ORCID iD: 0000-0002-9296-4346
SPIN-code: 4218-5028

Russian Federation, 5, Revolutsionnaya street, Yaroslavl, 150000

Postgraduate Student of the Department of Outpatient Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry with the EITI ORP Course

Leonid B. Shubin

Yaroslavl States Medical University

Email: lbsh@yandex.ru
ORCID iD: 0000-0003-4562-7731
SPIN-code: 8021-7289

Russian Federation, 5, Revolutsionnaya street, Yaroslavl, 150000

MD, PhD, Associate Professor

Artem D. Dyakiv

Yaroslavl States Medical University

Email: dyakivartyom@gmail.com
ORCID iD: 0000-0002-2124-0244
SPIN-code: 1858-1022

Russian Federation, 5, Revolutsionnaya street, Yaroslavl, 150000

graduate student of the department of surgical diseases

  1. Романчишен А.Ф., Вабалайте К.В., Романчишен Ф.А. Насколько оправданы изменения в редакции TNM классификация и стадирование рака щитовидной железы, определяющих выбор объема лечения больных или современные тренды в лечении больных РЩЖ / Сборник тезисов XXVII Всероссийского симпозиума по эндокринной хирургии с участием эндокринологов (Калининские чтения); Судак, 28–29 сентября 2017 г. Симферополь; 2017. – С. 109–110. [Romanchishen AF, Vebalaite KV, Romanchishen FA. Naskol’ko opravdany izmeneniya v redaktsii TNM klassifikatsiya i stadirovanie raka shchitovidnoi zhelezy, opredelyayushchikh vybor ob”ema lecheniya bol’nykh ili sovremennye trendy v lechenii bol’nykh RShchZh. In: Proceedings of the XXVII Symposium on endocrine surgery with the participation of endocrinologists; Sudak, 28–29 September 2017. Simferopol; 2017. P. 109–110. (In Russ).]
  2. Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А. и др. Клинические рекомендации. Диагностика и лечение (много) узлового зоба у взрослых // Эндокринная хирургия. – 2016. – Т.10. – №1 – C. 5–12. [Bel’tsevich DG, Vanushko VE, Mel’nitchenko GA, et al. Russian Association of Endocrinologists Clinic Guidelines for Thyroid Nodules Diagnostic and Treatment. Endocrinnaya khirurgiya. 2016;10(1):5–12. (In Rus.).]
  3. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009;19(11):1159–1165. doi: https://doi.org/10.1089/thy.2009.0274
  4. Воробьев С.Л. Морфологическая диагностика заболеваний щитовидной железы. – СПб.: Коста; 2014. – 104 c. [Vorob’ev SL. Morfologicheskaya diagnostika zabolevanii shchitovidnoi zhelezy. St. Petersburg: Costa; 2014. 104 p. (In Russ).]
  5. Тимофеева Л.А., Алешина Т.Н. Применение системы TI-RADs в дифференциальной диагностике рака щитовидной железы // Казанский медицинский журнал. – 2017. – Т.98. – №4 – С. 632–636. [Timofeeva EP, Aleshina TN. Use of TI-RADS system in differential diagnosis of thyroid cancer. Kazan Med Zh. 2017;98(4):632–636. (In Rus.).] doi: https://doi.org/10.17750/KMJ2017-632
  6. Фисенко Е.П., Сыч Ю.П., Ветшева Н.Н. К вопросу о классификации TI-RADS и стратификации признаков рака щитовидной железы по данным ультразвукового исследования // Медицинская визуализация. – 2017. – Т. 21. – №5 – С. 29–38. [Fisenko EP, Sych YuP, Vetsheva NN. On the classification of TI-RADS and stratification of signs of thyroid cancer according to ultrasound. Medical visualization. 2017;21(5):29–38. (In Rus.).] doi: https://doi.org/10.24835/1607-0763-2017-5-29-38
  7. Tessler FN, Middleton WD, Grant EG, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. Journal of the American College of Radiology. 2017;14(5):587–595. doi: https://doi.org/10.1016/j.jacr.2017.01.046
  8. Russ G, Bonnema SJ, Erdogan MF, et al. European Thyroid Association Guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TI-RADS. Eur Thyroid J. 2017;6(5):225–237. doi: https://doi.org/10.1159/000478927
  9. Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014;81 Suppl 1:1–122. doi: https://doi.org/10.1111/cen.12515.
  10. Moon WJ, Baek JH, Jung SL, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011;12(1):1–14. doi: https://doi.org/10.3348/kjr.2011.12.1.1
  11. Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract. 2016;22(5):622–639. doi: https://doi.org/10.4158/EP161208.GL
  12. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748–1751. doi: https://doi.org/10.1210/jc.2008-1724
  13. Dy JG, Kasala R, Yao C, et al. Thyroid Imaging Reporting and Data System (TI-RADS) in stratifying risk of thyroid malignancy at the medical city. Journal of the ASEAN Federation of Endocrine Societies. 2017;32(2):108–116. doi: https://doi.org/10.15605/jafes.032.02.03
  14. Митьков В.В., Иванишина Т.В., Митькова М.Д. Эластография сдвиговой волной в диагностике доброкачественных образований щитовидной железы // Ультразвуковая и функциональная диагностика. – 2015. – №1 – С. 10–21. [Mitkov VV, Ivanishina TV, Mitkova MD. Ultrasound shear wave elastography in benign thyroid nodules diagnosis. Ultrasound & functional diagnostics. 2015;(1):10–21. (In Russ).]

Supplementary files

Supplementary Files Action
1. Fig. 1. Factor analysis of the significance of ultrasonic signs of thyroid nodes. View (68KB) Indexing metadata
2. Fig. 2. Assessment of TI-RADS 5 traits in factor analysis. View (72KB) Indexing metadata
3. Fig. 3. Cluster analysis of ultrasonic features of TI-RADS. View (102KB) Indexing metadata
4. Fig. 4. Cluster analysis of ultrasonic features TI-RADS 5. View (91KB) Indexing metadata
5. Fig. 5. Ranking of patients with nodular thyroid pathology according to the TI-RADS and TBSRTC systems (in%). View (161KB) Indexing metadata
6. Fig. 6. The frequency of detection of thyroid pathology in a pathomorphological study depending on the TI-RADS cohort. View (138KB) Indexing metadata
7. Fig. 7. The frequency of detection of thyroid pathology in cytological and pathomorphological studies. View (181KB) Indexing metadata
8. Fig. 8. The degree of error in the diagnosis, depending on the composition of the information base presented for analysis. View (72KB) Indexing metadata

Views

Abstract - 185

PDF (Russian) - 3

Remote (Russian) - 6

Cited-By


PlumX

Dimensions


Copyright (c) 2019 Aleksandrov Y.K., Yanovskaya E.A., Shubin L.B., Dyakiv A.D.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies