Thyroid Nodule Margin Assessment Using ACR TI‐RADS: Adding Points for Macrolobulation Impairs Performance. (7th June 2022)

• Record Type: Journal Article
• Authors: Haug, Logan P.; Dahiya, Nirvikar; Young, Scott W.; Patel, Maitray D.
• Is Part Of: Journal of ultrasound in medicine. Volume 42:Number 2(2023)
• Page Start: 409
• Page End: 415
• Publication Date: 2022-06-07
• Subjects: ACR TI‐RADS -- lobulation -- margin -- thyroid; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.1002/jum.16034
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : Objective: We evaluated the performance of ACR TI‐RADS when points for lobulated margins are applied only when the margins meet a quantified measure of margin microlobulation and not applied when nodules only demonstrate macrolobulation. Methods: We retrospectively reviewed ultrasound and pathology records (May 01, 2018 to July 31, 2020) to find all thyroid nodules at one institution characterized as having lobulated margins using the ACR TI‐RADS lexicon and subsequently undergoing fine needle aspiration (FNA). Nodule margins were evaluated to note the presence or absence of microlobulation, quantitatively defined as a protrusion with a base <2.5 mm in length. The impact to detection of malignant nodules and avoidance of benign FNA when margin points for lobulation were added only when microlobulated was analyzed. Results: 58 of 516 thyroid nodules undergoing US‐guided FNA were classified as lobulated, comprising the study population. 21 (36.2%) had microlobulated margins, with 12 of the 21 (57.1%) being malignant. Comparatively, of the 37 nodules showing only macrolobulated margins without microlobulation, only 2 (5.4%) were malignant ( P < .0001). For 53 nodules ≥10 mm, 15 (28.3%) benign nodules would not have met size criteria for FNA had points for margins not been applied when only showing macrolobulation, whereas all 10 malignant nodules would still have been sampled. Conclusion: Adding two points to the ACR TI‐RADS score for lobulated thyroid nodules should only apply when microlobulations are present. Abstract : Access the CME test here and search by article title.