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Thyroid Nodule Margin Assessment Using ACR TI-RADS: Adding Points for Macrolobulation Impairs Performance.

Logan P Haug1, Nirvikar Dahiya1, Scott W Young1

  • 1Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
|June 7, 2022
PubMed
Summary
This summary is machine-generated.

For thyroid nodules, ACR TI-RADS points for lobulation should only be applied for microlobulations, not macrolobulations. This refinement improves accuracy in identifying malignant nodules and avoiding unnecessary fine needle aspirations (FNA).

Keywords:
ACR TI-RADSlobulationmarginthyroid

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Area of Science:

  • Radiology
  • Thyroid Imaging
  • Oncology

Background:

  • The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) uses a scoring system to assess thyroid nodule malignancy risk.
  • Lobulated margins are a feature that contributes points to the ACR TI-RADS score, potentially influencing the decision for fine needle aspiration (FNA).
  • Distinguishing between microlobulation and macrolobulation in nodule margins is crucial for accurate risk stratification.

Purpose of the Study:

  • To evaluate the performance of the ACR TI-RADS scoring system.
  • To determine if applying points for lobulated margins should be restricted to cases with microlobulation, excluding macrolobulation.
  • To assess the impact of this modification on the detection of malignant thyroid nodules and the avoidance of benign FNA procedures.

Main Methods:

  • Retrospective review of ultrasound and pathology records for thyroid nodules with lobulated margins undergoing FNA.
  • Quantitative evaluation of nodule margins to differentiate between microlobulation (protrusion base <2.5 mm) and macrolobulation.
  • Analysis of the impact on malignant nodule detection and benign FNA avoidance under the modified scoring criteria.

Main Results:

  • Of 516 nodules, 58 had lobulated margins; 21 (36.2%) were microlobulated and 37 (63.8%) were macrolobulated.
  • Malignancy rates were significantly higher in microlobulated nodules (57.1%) compared to macrolobulated ones (5.4%).
  • Applying margin points only for microlobulation would have prevented FNA in 15 benign nodules while still capturing all 10 malignant nodules ≥10 mm.

Conclusions:

  • The ACR TI-RADS system should assign points for lobulated margins exclusively when microlobulations are present.
  • This targeted application of points enhances the specificity of the ACR TI-RADS for identifying high-risk thyroid nodules.
  • Refining the criteria for lobulated margins can optimize the use of FNA, reducing unnecessary procedures for benign conditions.