Integrating Clinical Parameters into Thyroid Nodule Malignancy Risk: A Retrospective Evaluation Based on ACR TI-RADS

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Thyroid nodules are frequently detected via ultrasonography, with most being benign.
• Malignant nodules require fine needle aspiration (FNA) biopsy, but risk stratification is complicated by factors like age and sex.
• Current ultrasound-based risk systems may benefit from adjustments for clinical parameters.

Purpose of the Study:

• To evaluate if cytological malignancy rates of thyroid nodules can be refined by adjusting for clinical parameters.
• To assess the impact of age, sex, BMI, nodule size, autoimmunity, and thyroxine therapy on malignancy rates, independent of ACR TI-RADS.
• To analyze the predictive performance of ACR TI-RADS for malignant cytology across different age groups.

Main Methods:

• Retrospective review of fine needle aspiration (FNA) data from 1001 adult patients (1128 nodules).
• Malignancy classification based on cytopathology and histopathology.
• Statistical analysis of clinical parameters (age, sex, BMI, nodule size, autoimmunity, thyroxine therapy) adjusted for ACR TI-RADS categories.

Main Results:

• Malignancy rates varied by ACR TI-RADS category, nodule size, and patient age.
• Age was a significant predictor, with decreasing odds of malignancy in older patients across all ACR TI-RADS categories.
• Higher malignancy rates were observed in younger age groups and with larger nodules.

Conclusions:

• Adjusting the size threshold for FNA in TR3-3 nodules could improve accuracy.
• Integrating patient age and gender into risk assessment enhances the evaluation of thyroid nodules.
• These modifications can optimize clinical management decisions for thyroid nodules.