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British Thyroid Association 2014 classification ultrasound scoring of thyroid nodules, reproduced from literature. 2 .
Source publication
Objectives
To assess the inter-observer agreement amongst five observers of differing levels of expertise in applying the British Thyroid Association (2014) guidelines for ultrasound scoring of thyroid nodules (BTA-U score) in the management of thyroid cancer, and to assess the U-score diagnostic performance in predicting malignancy.
Method
A tota...
Contexts in source publication
Context 1
... Given the high background incidence of thyroid nodules and overall limited diagnostic accuracy of ultrasound, the main value of these systems lies in nodule selection, so as to safely detect all thyroid cancers, while minimising the number subject to cytological sampling, with associated patient anxiety and clinical cost. 2 As part of general guidelines on managing thyroid cancer, the British Thyroid Association (BTA, 2014) ultrasound (U-) classification of thyroid nodules was introduced, primarily to facilitate the decision of whether or not to proceed to FNAC. 2,14,15 Under this system, nodules are classified into categories U1 to U5, based on features including echogenicity, contour, halo, colloid artefact, calcification and vascularity (Figure 1). Under this classification, U1 represents normal thyroid parenchyma, U2 a benign nodule, U3 an indeterminate/ equivocal nodule, U4 a suspicious nodule and U5 a malignant nodule. ...
Context 2
... clear clinical advantage of the standardised nomenclature offered by all classification systems is in providing a common language for communicating ultrasound findings, reducing variability between operators in radiological reports. As outlined in Figure 1, the abbreviated BTA U-score (U ¼ 1-5) is sub-divided according to specific sonographic features, giving a detailed 17-point U-score: U2 (a-f), U3 (a-c), U4 (a-d) and U5 (a-e). ...
Context 3
... this comprised retrospective analysis of data acquired for standard clinical care, ethics committee review and informed consent were waived. The targeted ultrasound images of 73 individual nodules were retrospectively reviewed and classified according to the BTA 2014 U-score (Figure 1). Seventy-two of the 73 examinations were performed prior to regional adoption of the BTA U-classification in July 2014. ...
Context 4
... the range of diagnostic performance across the observers, all five observers achieved 100% sensitivity for detecting malignancy. While the specificity obtained by the senior sonographer matched that of the most senior observer, it was lower for all three other less experienced observers where between 55 and 57 patients Table 3. Inter-observer agreement between five independent observers for the BTA U-scoring of thyroid nodules (see Figure 1). were classified as having equivocal or suspicious features at ultrasound (compared with 54 - Table 4). ...
Context 5
... diagnostic accuracy for the most experienced observer above was based upon the abbreviated BTA U-scoring (U1-5), for which 34 of the nodules that received a scoring of U3 (and warranting FNAC) did so on the basis of mixed vascularity alone, with otherwise benign features. These nodules would have received a detailed U-score subcategory of U3c (Figure 1). If this mixed vascularity was removed from the sonographic evaluation (i.e. ...
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Purpouse:
Thyroid nodules are unusual findings in children. Some authors highlight the higher rate of malignancy in this group. The Bethesda system, created in adults to stratify thyroid nodules according to the risk of malignancy, constitutes a reference system for the management of this pathology. The American Thyroid Association promotes its us...
Citations
... There are five EU-TIRADS categories: EU-TIRADS 1: normal thyroid lesions, EU-TIRADS 2: benign lesions such us cysts, EU-TIRADS 3: low risk (2-4%) lesions as for isoechoic/hyperechoic nodules with smooth margins, EU-TIRADS 4: intermediate risk (6-17%) lesions such as ovoid, mildly hypoechoic nodules with smooth margins, EU-TIRADS 5: high risk (26-87%) lesions for nodules with suspicious characteristics such as irregular shape or margins, micro-calcifications, taller than wide morphology and markedly hypoechoic solid lesions [7]. Finally, the British Thyroid Association (BTA) classified TNs into 5 categories; U1 = normal thyroid gland, U2 = benign TN, U3 = intermediate/equivocal TN, U4 = suspicious TN, and U5 = malignant TN [8]. ...
Introduction: Thyroid nodule incidence is increasing due to the widespread application of ultrasonography. Fine-needle aspiration cytology is widely applied for the detection of malignancies. The aim of this study was to evaluate the predictive value of ultrasonography in thyroid cancer. Methods: This retrospective study included patients that underwent total thyroidectomy for benign thyroid disease or well-differentiated thyroid carcinoma from January 2017 to December 2022. The study population was divided into groups: the well-differentiated thyroid cancer group and the control group with benign histopathological reports. Results: In total, 192 patients were enrolled in our study; 159 patients were included in the well-differentiated thyroid cancer group and 33 patients in the control group. Statistical analysis demonstrated that ultrasonographic findings such as microcalcifications (90.4%), hypoechogenicity (89.3%), irregular margins (92.2%) and taller-than-wide shape (90.5%) were correlated to malignancy (p < 0.001). Uni- and multivariate analysis revealed that both US score (OR: 2.177; p < 0.001) and Bethesda System (OR: 1.875; p = 0.002) could predict malignancies. In terms of diagnostic accuracy, the US score displayed higher sensitivity (64.2% vs. 33.3%) and better negative predictive value (34.5% vs. 24.4%) than the Bethesda score, while both scoring systems displayed comparable specificities (90.9% vs. 100%) and positive predictive values (97.1% vs. 100%). Discussion: The malignant potential of thyroid nodules is a crucial subject, leading the decision for surgery. Ultrasonography and fine-needle aspiration cytology are pivotal examinations in the diagnostic process, with ultrasonography demonstrating better negative predictive value.
... However, it is unclear whether it is a risk factor for PTC recurrence. The American Thyroid Association (ATA) 2015, National Comprehensive Cancer Network (NCCN) 2019, and British Thyroid Association (BTA) 2014 are widely known international guidelines (8)(9)(10). However, comparisons between the guidelines reveals that small differences in risk factors for PTC recurrence among each guideline can be observed (Table I). ...
... Recurrence has been reported to occur in ~7-23% of patients with PTC. In addition to TNM, other risk categories that have been proposed for PTC include age, grade, extent and size (AGES), age, metastasis, extent and size (AMES) and metastasis, age, complete resection, invasion and size (MACIS), with the corresponding factors including age, sex, extrathyroidal infiltration, tumor size, lymph node metastasis, distant metastasis, and differentiation by pathological diagnosis (8)(9)(10)(11). Although there are some differences of race or in the medical care system, key risk factors are common, indicating that there is universality in factors derived from previous reports. ...
... Actually, 31 out of 64 patients with lymphovascular invasion, or about half, had lateral cervical lymph node metastasis (Table IV). In ATA 2015, NCCN 2019 and BTA 2014, extrathyroidal infiltration and lymph node metastasis (N1) were listed as high-risk factors (8)(9)(10). Lateral cervical lymph node metastasis was present in 57 out of 148 patients with extrathyroidal infiltration and in 74 out of 170 patients with paratracheal lymph node metastasis. ...
Currently, there is a lack of evidence-based risk factors for the lateral cervical lymph node metastasis of papillary thyroid carcinoma (PTC). Thus, the risk factors and recurrence rate of lateral cervical lymph node metastasis were investigated in the present study for patients with PTC who underwent initial radical surgery. The data of 274 patients with PTC who underwent initial radical surgery over a 10-year period from January, 2009 to December, 2018 were retrospectively analyzed. By applying univariate analysis, lymphovascular invasion, venous invasion, extrathyroidal infiltration, paratracheal lymph node metastasis and tumor size were designated as significant risk factors for lateral cervical lymph node metastasis. As regards multivariate analysis, paratracheal lymph node metastasis and tumor size were identified as independent risk factors. The recurrence rate was higher in patients presenting with lateral cervical lymph node metastasis, and the disease-free survival rate was significantly lower in the patient group presenting with lateral cervical lymph node metastasis. On the whole, the present study demonstrated that paratracheal lymph node metastasis and tumor size were independent risk factors for lateral cervical lymph node metastasis.
... Thyroid ▪ Characteristics of malignant thyroid nodules ▪ Systematic nodule classification (e. g., EU-TIRADS/BTA U classification) and indications for when to perform an ultrasound-guided biopsy [27,28]. ...
Different surgical and medical specialists increasingly use head and neck
ultrasound and ultrasound-guided interventions as part of their clinical
practice. We need to ensure high quality and standardized practice across
specialties, and this position paper of the European Federation of Societies for
Ultrasound in Medicine and Biology (EFSUMB) describes the training requirements
for head and neck ultrasound. Traditionally, a minimum number of ultrasound
examinations indicates competence, but this is unreliable, and a general shift
towards competence-based training is ongoing. For each EFSUMB level, we will
outline the theoretical knowledge and skills needed for clinical practice. The
recommendations follow the three EFSUMB competency levels for medical ultrasound
practice. Level 1 describes the skills required to perform essential head and
neck ultrasound examinations independently, level 2 includes ultrasound-guided
interventions, while level 3 involves the practice of high-level neck ultrasound
and use of advanced technologies. Our goal is to ensure high quality and
standardized head and neck ultrasound practice performed by different clinical
specialists with these recommendations.
... The British Thyroid Association U1-5 scoring system allows for clinical decision making when performing ultrasound of thyroid nodules (Weller et al, 2020). Nodules that are classified as U3 and above are normally biopsied. ...
Upon discovery of a thyroid nodule (or nodules), a patient is usually referred for evaluation by ultrasound, which is typically performed by a trained radiologist or sonographer. More recently, this technology has been used intraoperatively by endocrine surgeons and also by endocrinologists, often in the context of 'one-stop shops' or point of care ultrasound in the outpatient setting. Although thyroid nodules are common and most will be benign, the subsequent work up of these can cause anxiety for patients and place a burden on radiologists. In the UK, sonographic features of benign, suspicious or malignant nodules are classified by the British Thyroid Association U1-U5 criteria, which decide whether to biopsy the nodule (typically U3 and above). This article provides an overview of ultrasound in assessing the thyroid nodule in the context of this classification. This can be used as a guide to interpretation of thyroid ultrasonography for non-radiologists.
... U1 indicates normal thyroid without nodules, U2 suggests benign lesions, whereas U3 nodules are indeterminate or equivocal and can imply a malignant nature from this group onwards. U4 nodules are suspicious for malignancy, while U5 nodules are cancerous [6,19,20]. The guidelines suggest that patients with U2 nodules without other malignancy risk factors do not require further invasive diagnosis, while patients with U3-U5 as well as U2 with increased cancer risk factors should be biopsied for cytological evaluation [6]. ...
... This classification has been proven to be a reliable screening instrument in adults for differentiating between benign and malignant thyroid lesions in several studies. Therefore, such classification makes the decision whether to perform an FNAB much easier [19][20][21][22]. ...
The risk of malignancy in thyroid nodules correlates with the presence of ultrasonographic features. In adults, ultrasound risk-classification systems have been proposed to indicate the need for further invasive diagnosis. Furthermore, elastography has been shown to support differential diagnosis of thyroid nodules. The purpose of our study was to assess the application of the American Thyroid Association (ATA), British Thyroid Association (BTA) ultrasound risk-classification systems and strain elastography in the management of thyroid nodules in children and adolescents from one center. Seventeen nodules with Bethesda III, IV, V and VI were selected from 165 focal lesions in children. All patients underwent ultrasonography and elastography followed by fine needle aspiration biopsy. Ultrasonographic features according to the ATA and BTA stratification systems were assessed retrospectively. The strain ratio in the group of thyroid nodules diagnosed as malignant was significantly higher than in benign nodules (6.07 vs. 3.09, p = 0.036). According to the ATA guidelines, 100% of malignant nodules were classified as high suspicion and 73% of benign nodules were assessed as low suspicion. Using the BTA U-score classification, 80% of malignant nodules were classified as cancerous (U5) and 20% as suspicious for malignancy (U4). Among benign nodules, 82% were classified as indeterminate or equivocal (U3) and 9% as benign (U2). Our results suggest that application of the ATA or BTA stratification system and elastography may be a suitable method for assessing the level of suspected malignancy in thyroid nodules in children and help make a clinical decision about the need for further invasive diagnosis of thyroid nodules in children.
... Guidelines for the ultrasound diagnosis of thyroid nodules in adults are established and widely used [26,[34][35][36]. However, it is debated whether the same guidelines can be applied to the pediatric population to effectively differentiate between benign and malignant lesions. ...
Thyroid nodules are common in the adult population (13%), but in childhood, they are relatively rarely diagnosed (0.2–5%). The risk factors and diagnostic and therapeutic algorithms are well-known and effectively used in adults, but no clear procedures supported by scientific research are available in the pediatric population. Our aim in this study was to identify predictive factors for thyroid cancer in a pediatric population. We retrospectively analyzed 112 children (80 girls and 32 boys, aged 0.6–18 years, with an average group age of 13.4 ± 4.5 years) with thyroid nodules who presented or were referred between 2010 and 2021. A total of 37 children qualified for partial or total thyroidectomy. After histopathological nodule examination, the most common cases were benign lesions in 23 patients (57.5%) and malignant lesions in 14 children (32.5%). Solitary benign thyroid nodules were found in 16 children (40%). Malignancy risk was higher in children with increased nodule diameter (greater than 7 mm; p = 0.018) or hypoechogenic lesions in ultrasound (p = 0.010), with no correlation between increased blood flow in the vessels and tumor diagnosis. The relative risk of developing thyroid cancer for class III was found to be higher in comparison to adults and 11.1 times higher than for classes I and II combined.
... The proportions of patients with cancer in U1-U5 categories were 0%, 13.6%, 30.4%, 40%, and 100%, respectively [4]. In another study of 73 consecutive patients with 17 histological confirmed malignant nodules, it was found that the sensitivity and NPV of BTA-U score in detecting and predicting malignancy were 100%, whereas the specificity and PPV were 34% and 32%, respectively [5]. ...
Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains.
... The British Thyroid Association (BTA) in 2014 provided guidelines for US scoring of thyroid nodules (BTA-U score) to assist in the management of thyroid cancer [40]. Briefly, it allows for stratifying thyroid nodules as benign, suspicious, or malignant based on ultrasound appearances termed U1-U5. ...
... Weller et al. studied 73 consecutive cases evaluated by five sonographers [40]. Their results suggested that there was substantial inter-observer agreement, culminating in 100% sensitivity and negative predictive value, with low specificity (32%) and specificity (34%). ...
The increasing application of ultrasound (US) in recent years has led to a greater number of thyroid nodule diagnoses. Consequently, the number of fine needle aspirations performed to evaluate these lesions has increased. Although the majority of thyroid nodules are benign, identifying methods to define specific lesions and tailor risk of malignancy has become vital. Some of the tools employed to stratify thyroid nodule risk include clinical factors, thyroid US findings, and reporting systems for thyroid cytopathology. Establishing high concordance between US features and cytologic diagnoses might help reduce healthcare costs by diminishing unnecessary thyroid procedures and treatment. This review aims to review radiology US classification systems that influence the practice of thyroid cytology.
... Therefore, researches worked on inter-observer agreement. A study by Couzins et al., [57] found no statistically significant inter-or intra-observer variability in the U-scoring of thyroid nodules between 14 recruited participant US operators, thus reinforcing the validity of this scoring method in clinical practice and allaying concerns regarding potential subjective biases in reporting. A study by Weller et al., [58] revealed very good inter-observer agreement in using the BTA-U score amongst different observers at differing levels of expertise. ...
... Our study shows that TIRADS is significantly more specific in recommending FNA relative to the BTA U classification, but this is at the cost of being significantly less sensitive. The high sensitivity of the BTA U classification has been shown previously 11,15,16 . ...
Introduction
The British Thyroid Association (BTA) recommend ultrasound assessment of thyroid nodules using the U classification. The American College of Radiologists (ACR) recommend assessment with the Thyroid Imaging Reporting and Data System (TIRADS). We conduct the first UK study to compare these two systems.
Methods
Ultrasound (US) reports of patients who underwent surgical excision of thyroid nodules over a 10-year period in one UK centre were reviewed. US findings were collected, and the classifications were retrospectively applied. The systems were compared to histopathological diagnosis.
Results
308 nodules in 296 patients are included. 135 nodules (43.8%) were malignant. U classification showed sensitivity of 88.1% in recommending FNA, significantly higher than TIRADS at 73.3% (p=0.0002). The U classification showed specificity of 41.6%, significantly lower than TIRADS at 64.2% (p=<0.0001). PPV between classifications at equivalent levels showed no significant difference at U3/TR-3 (p=0.81), U4/TR-4 (p=0.30) or U5/TR-5 (p=0.90).
Discussion
Classification systems enable risk stratification of potentially malignant thyroid nodules. This study shows BTA U classification has a higher sensitivity but lower specificity than TIRADS.
