Indian Journal of Endocrine Surgery and Research

Register      Login

VOLUME 18 , ISSUE 1 ( January-June, 2023 ) > List of Articles

Original Article

Evaluation of Concordance of Ultrasound, Cytology, and Histopathology in Solitary Thyroid Nodules

Yashwant S Rathore, Gopal Puri, Sushma Yadav, Surabhi Vyas, Kanika Sharma, Amit Patidar

Keywords : Bethesda, Concordance, Risk of malignancy, Solitary thyroid nodule, Thyroid Imaging and Reporting Data System

Citation Information : Rathore YS, Puri G, Yadav S, Vyas S, Sharma K, Patidar A. Evaluation of Concordance of Ultrasound, Cytology, and Histopathology in Solitary Thyroid Nodules. 2023; 18 (1):17-23.

DOI: 10.5005/jp-journals-10088-11204

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The American College of Radiology (ACR)-Thyroid Imaging and Reporting Data System (TIRADS) is used to classify the ultrasound (USG) findings and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is used to classify the fine needle aspiration (FNAC) findings for a solitary thyroid nodule (STN). Objective: The objective of this study is to assess the concordance between TIRADS and TBSRTC with final postoperative histopathology in cases of STN and to calculate the risk of malignancy (ROM). Materials and methods: The prospective observational study was conducted at a tertiary care hospital in India. Patients underwent USG and FNAC before undergoing surgery. Final concordance was analyzed with histopathology examination. Results: The study included 80 subjects. The ROM for the TIRADS categories was 25.92%, 65.21%, and 100% for TIRADS (TR)3, TR4, and TR5 nodules, respectively. The ROM for Bethesda categories was 0% for Bethesda (B) I (BI), 6.5% for BII, 47.36% for BIII, 46.67% for BIV, and 100% for BV and BVI. Concordance was calculated using the kappa index, which was 0.21 with SE = 0.08 and 95% confidence interval (CI) = 0.061–0.359. After broad categorization, the re-calculated kappa was 0.38 with SE = 0.09 (95% CI: 0.203–0.564) with the observed agreement of 64% and by chance agreement of 41.6%. Conclusion: There is fair concordance between ACR-TIRADS and TBSRTC. Indeterminate concordant and discordant nodules mandate a closer look owing to the high ROM.

  1. Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 1996;156(19):2165–2172. DOI: 10.1001/archinte.156.19.2165.
  2. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328(8):553–559. DOI: 10.1056/NEJM199302253280807.
  3. Ezzat S, Sarti DA, Cain DR, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 1994;154(16):1838–1840. DOI: 10.1001/archinte.154.16.1838.
  4. Mistry R, Hillyar C, Nibber A, et al. Ultrasound classification of thyroid nodules: A systematic review. Cureus 2020;12(3):e7239. DOI: 10.7759/cureus.7239.
  5. Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: A systematic review and meta-analysis of observational studies. Thyroid 2015;25(5):538–550. DOI: 10.1089/thy.2014.0353.
  6. Middleton WD, Teefey SA, Reading CC, et al. Multiinstitutional analysis of thyroid nodule risk stratification using the American College of Radiology Thyroid Imaging Reporting and Data System. Am J Roentgenol 2017;208(6):1331–1341. DOI: 10.2214/AJR.16.17613.
  7. Baloch ZW, LiVolsi VA, Asa SL, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36(6):425–437. DOI: 10.1002/dc.20830.
  8. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017;27(11):1341–1346. DOI: 10.1089/thy.2017.0500.
  9. Kisansa M, Botha M, Greeff W. American College of Radiology thyroid imaging reporting and data system standardises reporting of thyroid ultrasounds. SA j radiol 2020;24(1):1–7. DOI: 10.4102/sajr.v24i1.1804.
  10. Jabar ASS, Koteshwara P, Andrade J. Diagnostic reliability of the Thyroid Imaging Reporting and Data System (TI-RADS) in routine practice. Pol J Radiol 2019;84:e274–280. DOI: 10.5114/pjr.2019.86823.
  11. Chng CL, Tan HC, Too CW, et al. Diagnostic performance of ATA, BTA and TIRADS sonographic patterns in the prediction of malignancy in histologically proven thyroid nodules. Singapore Med J. 2018;59(11):578–583. DOI: 10.11622/smedj.2018062.
  12. Wu HH-J, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: Ten years experience in a community teaching hospital. Diagn Cytopathol 2006;34(2):93–96. DOI: 10.1002/dc.20389.
  13. Mazzaferri EL. Management of low-risk differentiated thyroid cancer. Endocr Pract 2007;13(5):498–512. DOI: 10.4158/EP.13.5.498.
  14. Schenke S, Rink T, Zimny M. TIRADS for sonographic assessment of hypofunctioning and indifferent thyroid nodules. Nuklearmedizin 2015;54(3):144–150. DOI: 10.3413/Nukmed-0712-14-12.
  15. Vargas-Uricoechea H, Meza-Cabrera I, Herrera-Chaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid Res 2017;10(1):1–9. DOI: 10.1186/s13044-017-0037-2.
  16. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26(1):1–133. DOI: 10.1089/thy.2015.0020.
  17. Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91(9):3411–3417. DOI: 10.1210/jc.2006-0690.
  18. Keh SM, El-Shunnar SK, Palmer T, et al. Incidence of malignancy in solitary thyroid nodules. J Laryngol Otol 2015;129(7):677–681. DOI: 10.1017/S0022215115000882.
  19. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008;22(6):901–911. DOI: 10.1016/j.beem.2008.09.019.
  20. Paschou SA, Vryonidou A, Goulis DG. Thyroid nodules: A guide to assessment, treatment and follow-up. Maturitas 2017;96:1–9. DOI: 10.1016/j.maturitas.2016.11.002.
  21. Panato C, Vaccarella S, Dal Maso L, et al. Thyroid cancer incidence in India between 2006 and 2014 and impact of overdiagnosis. J Clin Endocrinol Metab 2020;105(8):2507–2514. DOI: 10.1210/clinem/dgaa192.
  22. Kung AWC, Chau MT, Lao TT, et al. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab 2002;87(3):1010–1014. DOI: 10.1210/jcem.87.3.8285.
  23. Russ G, Bonnema SJ, Erdogan MF, et al. European Thyroid Association Guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J 2017;6(5):225–237. DOI: 10.1159/000478927.
  24. Chandramohan A, Khurana A, Pushpa BT, et al. Is TIRADS a practical and accurate system for use in daily clinical practice? Indian J Radiol Imaging 2016;26(1):145–152. DOI: 10.4103/0971-3026.178367.
  25. 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: 10.1210/jc.2008-1724.
  26. Park J-Y, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid: Off J Am Thyroid Assoc 2009;19(11):1257–1264. DOi: 10.1089/thy.2008.0021.
  27. Al Dawish MA, Alwin Robert A, Thabet MA, et al. Thyroid nodule management: Thyroid-stimulating hormone, ultrasound, and cytological classification system for predicting malignancy. Cancer Inform 2018;17:1176935118765132. DOi: 10.1177/1176935118765132.
  28. Srinivas MNS, Amogh VN, Gautam MS, et al. A prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions. J Clin Imaging Sci 2016;6:5. DOI: 10.4103/2156-7514.177551.
  29. Bongiovanni M, Spitale A, Faquin WC, et al. The Bethesda system for reporting thyroid cytopathology: A meta-analysis. Acta cytol 2012;56(4):333–339. PMID: 22846422.
  30. Agarwal S, Jain D. Thyroid cytology in India: Contemporary review and meta-analysis. J Pathol Transl Med 2017;51(6):533–547. DOI: 10.4132/jptm.2017.08.04.
  31. Poller DN, Bongiovanni M, Trimboli P. Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta-analysis. Cancer Cytopathol 2020;128(1):36–42. DOI: 10.1002/cncy.22201.
  32. Inabnet WB, Palazzo F, Sosa JA, et al. Correlating the Bethesda system for reporting thyroid cytopathology with histology and extent of surgery: A Review of 21,746 patients from four endocrine surgery registries across two continents. World J Surg 2020;44(2):426–435. DOI: 10.1007/s00268-019-05258-7.
  33. Chen Y-H, Partyka KL, Dougherty R, et al. The importance of risk of neoplasm as an outcome in cytologic-histologic correlation studies on thyroid fine needle aspiration. Diagn Cytopathol 2020;48(12):1237–1243. DOI: 10.1002/dc.24557.
  34. Cibas ES, Alexander EK, Benson CB, et al. Indications for thyroid FNA and pre-FNA requirements: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36(6):390–399. DOI: 10.1002/dc.20827.
  35. Mathai AM, Preetha K, Valsala Devi S, et al. Analysis of malignant thyroid neoplasms with a striking rise of papillary microcarcinoma in an endemic goiter region. Indian J Otolaryngol Head Neck Surg 2019;71(S1):121–130. DOI: 10.1007/s12070-017-1156-8.
  36. Rahal A, Falsarella PM, Rocha RD, et al. Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1,000 nodules. Einstein (São Paulo) 2016;14:119–123. DOI: 10.1590/S1679-45082016AO3640.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.