The KWAK TI-RADS and 2015 ATA guidelines for medullary thyroid carcinoma and Papillary Thyroid Carcinoma: combined with cell block assisted ultrasound guided thyroid fine needle aspiration

Published: 31-08-2019| Version 1 | DOI: 10.17632/6xcp2md4tt.1
jianming Li,
Lin-Xue Qian


The operative pathology results showed that 29 patients had MTC (male:female, 11:18), 31 patients had PTC (male:female, 5:26), and 33 patients had TA (male:female, 4:29) . The mean patient ages in the MTC, PTC, and TA groups were 55.21±2.95, 43.84±2.33, and 53.67±2.42 years, respectively. The mean sizes of the MTCs, PTCs, and TAs were 1.72±0.18, 1.05±0.09, and 1.88±0.2 cm, respectively. No study has compared the diagnosis of MTC and PTC using the KWAK TI-RADS and 2015 ATA guidelines, and combined CB and ultrasound guided FNA in MTC. Therefore, the purpose of this study was to evaluate the applicability of the TI-RADS and 2015 ATA guidelines to patients with MTC and PTC, and to find the role of CB assisted FNA in MTC.


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The Radiological Society of North America recommends defining US features through the TI-RADS. Echogenicity was classified as hyperechogenicity, isoechogenicity, hypoechogenicity, or marked hypoechogenicity. When the echogenicity of the nodule was similar to that of the thyroid parenchyma, it was classified as isoechoic. The nodule was classified as having marked hypoechogenicity if the echogenicity was less than that of the surrounding strap muscle. Margins were classified as well defined or poorly defined. Microcalcifications were defined as ≤1-mm hyperechoic foci with or without acoustic shadows, and colloids with clear comet-tail artifacts were excluded. Macrocalcifications were defined as >1-mm hyperechoic foci. Tumors with a taller-than-wide shape were evaluated using transverse sections. 2015 ATA guideline Thyroid nodules were assigned to one of the following risk estimates of malignancy, according to the sonographic patterns in the 2015 ATA guideline 7. High suspicion: solid hypoechoic nodule or solid hypoechoic component of a partially cystic nodule with one or more of the following features: irregular margins, microcalcifications, taller-than-wide shape, disrupted rim calcifications with small extrusive soft tissue components, or evidence of ETE Intermediate suspicion: hypoechoic solid nodule with smooth margins without microcalcifications, ETE, or taller-than-wide shape Low suspicion: isoechoic or hyperechoic solid nodule or partially cystic nodule with eccentric solid areas without microcalcification, irregular margins, ETE, or taller-than-wide shape Very low suspicion: spongiform or partially cystic nodules without any of the sonographic features described in the low-, intermediate-, or high-suspicion patterns Benign: purely cystic nodules (no solid component) KWAK TI-RADS The TI-RADS patterns for US features of thyroid nodules was proposed by Kwak et al. 6. Suspicious US features included a solid component, hypoechogenicity, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. The TI-RADS categories are as follows: 2, benign lesions, including cysts and spongiform nodules; 3, no suspicious US features; 4a, one suspicious US feature; 4b, two suspicious US features; 4c, three or four suspicious US features; and 5, five suspicious US features. SPSS statistical software version 19 (IBM Corp., Armonk, NY, USA) was used to analyze the data. US analysis data from the most experienced reviewer was used for comparative statistics. Data are shown as mean ± standard deviation and range. We compared normally distributed data using Student’s unpaired t test and non-normally distributed data using the Mann–Whitney test. Comparisons of categorical data were performed using the 𝜒2 test. The diagnostic sensitivity, specificity and accuracy of KWAK TI-RADS, and the 2015 ATA guidelines were calculated and compared.