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The TNAPP web-based algorithm improves thyroid nodule management in clinical practice: A retrospective validation

Vincenzo Triggiani1, Giuseppe Lisco1, Giuseppina Renzulli2

  • 1Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.

Frontiers in Endocrinology
|February 13, 2023
PubMed
Summary

The Thyroid Nodule App (TNAPP) shows promise in improving thyroid nodule management by enhancing sensitivity and reducing missed diagnoses. This web-based tool offers a reliable method for selecting nodules for fine-needle aspiration (FNA).

Keywords:
TNAPPfine-needle aspiration (FNA)retrospective studythyroid carcinomathyroid noduleweb-based algorithm

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Area of Science:

  • Endocrinology
  • Oncology
  • Medical Informatics

Background:

  • Increasing detection of thyroid nodules necessitates improved management strategies.
  • Fine-needle aspiration (FNA) and cytology are extensively used but require tailored approaches.
  • Web-based tools and algorithms can aid in optimizing thyroid nodule evaluation.

Purpose of the Study:

  • To assess the performance of the Thyroid Nodule App (TNAPP), an interactive algorithmic tool, in managing thyroid nodules.
  • To compare TNAPP's diagnostic accuracy with existing algorithms like AACE/ACE/AME and ACR TI-RADS.
  • To evaluate TNAPP's effectiveness in reducing unnecessary FNA procedures.

Main Methods:

  • Retrospective evaluation of 188 thyroid nodules from 112 patients who underwent FNA and surgery.
  • Analysis of neck ultrasound images to extract data for TNAPP evaluation.
  • Calculation of sensitivity, specificity, predictive values, and accuracy of TNAPP, compared to AACE/ACE/AME and ACR TI-RADS.

Main Results:

  • TNAPP demonstrated high sensitivity (>80%) and a negative predictive value of 68%, with overall accuracy comparable to the AACE/ACE/AME algorithm.
  • TNAPP showed a slight advantage in discriminating against unnecessary FNA for benign nodules.
  • The app reduced missed diagnoses for suspicious and highly suspicious nodules, with only 14 malignant nodules missed, mostly microcarcinomas.

Conclusions:

  • The TNAPP algorithm is a reliable and easy-to-use tool for improving the selection of thyroid nodules for cytological assessment.
  • TNAPP demonstrated a lower rate of missed malignant nodules compared to other algorithms, particularly for microcarcinomas.
  • Further studies are needed to validate TNAPP and guide future iterations for enhanced diagnostic accuracy and reduced unnecessary procedures.