Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules: a meta-analysis

in European Journal of Endocrinology
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  • 1 National Institute of Gastroenterology ‘S. de Bellis’, Research Hospital, Castellana Grotte, Italy
  • 2 Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
  • 3 Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, University of Latvia, Radiology Research laboratory, Riga Stradins University, Riga, Latvia
  • 4 Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
  • 5 Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
  • 6 Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
  • 7 Head Neck and Thyroid Imaging, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
  • 8 Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

Correspondence should be addressed to P Trimboli; Email: pierpaolo.trimboli@eoc.ch
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Objective:

Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published.

Design:

We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions.

Methods:

Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data.

Results:

Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0–1.3), 5.9% (95% CI: 2.6–9.2), 21.4% (95% CI: 11.1–31.7), and 76.1% (95% CI: 63.7–88.5). Sensitivity, specificity, PPV, NPV, LR+, LR− and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5–89.8), 84.3% (95% CI: 66.2–93.7), 76.1% (95% CI: 63.7–88.5), 85.4% (95% CI: 79.1–91.8), 4.9 (95% CI: 2.9–8.2), 0.2 (95% CI: 0.1–0.3), and 24.5 (95% CI: 11.7–51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5.

Conclusions:

A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.

Supplementary Materials

    • Supplementary Table 1: PRISMA-DTA for Abstract Checklist
    • Supplementary Table 2: PRISMA-DTA Checklist
    • Supplementary Table 3: Summary estimates of the diagnostic performance of EU-TIRADS class 5 versus 2, 3 and 4 in selecting malignant nodules: results of the sensitivity analysis.
    • Supplementary Table 4: Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
    • Supplementary Figure 1
    • Supplementary Figure 2

 

     European Society of Endocrinology

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