Eya Azzouz1, Meriem Jrad2*, Haifa Zlitni2, Seif Boukriba1, Wassim Frikha1, Miriam Boumediene2, Jihene Marrakchi3, Rym Zainine3, Lamia Charfi4 and Habiba Mizouni1
1Department of Radiology, La Rabta Hospital, Tunisia
2Department of Radiology, Charles Nicolles University Hospital, Tunisia
3Department of ENT, La Rabta Hospital, Tunisia
4Department of Anatomic Pathology, Salah Azaiez Institute, Tunisia
Purpose: To evaluate the diagnostic accuracy of ACR (American College of Radiology) and EU (European)-TIRADS 2017 by correlating the ultrasound data to the cytological findings and to study the agreement of these two systems for predicting malignancy.
Materials and Methods: A prospective and analytic study was conducted at the radiology department of Charles Nicolle University hospital from November 2020 to June 2021.
All the nodules included in the study had been classified according to the ACR-TIRADS guidelines before Fine Needle Non Aspiration Cytology (FNNAC). Then, ultrasound findings were reclassified according to the EU-TIRADS. The cytological results were categorized according to BETHEZDA 2018.
The Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of TIRADS systems and their statistical relationship with the cytological results were calculated. The study of the agreement between the two systems was performed by Cohen's Kappa coefficient.
Results: Our study included 124 nodules (120 patients, 87.5% women with average age of 53.1 years). The distribution of the nodules according to the ACR-TIRADS was respectively 22%, 55% and 23% for TIRADS (TR) 3, TR4 and TR5. According to EU-TIRADS, it was respectively 26%, 36% and 38%. The cytological results were respectively 31.5%, 35.5%, 6.5%, 12.9%, 9.7% and 4% for the Bethesda 1, 2, 3, 4, 5 and 6 categories. Excluding Bethesda 1, 3 and 4 nodules, a statistically significant relationship between the ultrasound risk level of both TIRADS and the cytological result was established. By proceeding in the same way, the sensibility, specificity, PPV and NPV were almost similar for both TIRADS systems and respectively: 100%, 36.4%, 37.8%, 100% for ACRTIRADS and 100%, 31.8%, 36.1% and 100% for EU-TIRADS. The agreement between the two systems was good and no significant difference was noticed.
Conclusion: This study confirmed the excellent sensitivity of both TIRADS with a NPV approaching 100% to avoid unnecessary FNNACs. The agreement between ACR and EU-TIRADS 2017 was good with equivalent diagnostic value.
Azzouz E, Jrad M, Zlitni H, Boukriba S, Frikha W, Boumediene M, et al. Ultrasound Assessment of Thyroid Nodules and Cytological Correlation: Comparative Study between ACR and EU-TIRADS 2017. Am J Otolaryngol Head Neck Surg. 2021; 4(9): 1160..