Browsing by Author "Trimboli, Pierpaolo"

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    Head-to-head comparison of American, European, and Asian TIRADSs in Thyroid Nodule Assessment : Systematic Review and Meta-Analysis
    (2024-04-01) Piticchio, Tommaso; Russ, Gilles; Radziņa, Maija; Frasca, Francesco; Durante, Cosimo; Trimboli, Pierpaolo; Department of Radiology
    Context Ultrasound-based risk stratification systems (TIRADSs) of thyroid nodules (TNs) have been implemented in clinical practice worldwide, based on their high performance. However, it remains unexplored whether different TIRADSs perform uniformly across a range of TNs in routine practice. This issue is highly relevant today, given the ongoing international effort to establish a unified TIRADS (i.e. I-TIRADS), supported by the leading societies specializing in TNs. The study aim was to conduct a direct comparison among ACR-, EU-, and K-TIRADS in the distribution of TNs: 1) across the TIRADS categories, and 2) based on their estimated cancer risk. Methods A search was conducted on Pubmed and Embase until June 2023. Original studies that sequentially assessed TNs using TIRADSs, regardless of FNAC indication, were selected. General study characteristics and data of distribution of TNs across TIRADSs were extracted. Results Seven studies, reporting a total of 41,332 TNs, were included in the analysis. The prevalence of ACR-TIRADS 1-2 was significantly higher than that of EU-TIRADS 2 and K-TIRADS 2, with no significant difference observed among intermediate- and high-risk categories of TIRADSs. According to malignancy risk estimation, K-TIRADS often classified TNs as having more severe risk, ACR-TIRADS as moderate risk, while EU-TIRADS classified TNs as lower risk. Conclusions ACR-, EU-, and K-TIRADS assess TNs similarly across their categories, with slight differences in low-risk classifications. Despite this, focusing on cancer risk estimation, the three TIRADSs assess TNs differently. These figures should be considered as prerequisite for developing the I-TIRADS.
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    Non‐Marked Hypoechogenic Nodules : Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison
    (2022-02-09) Prieditis, Peteris; Radzina, Maija; Mikijanska, Madara; Liepa, Mara; Stepanovs, Kaspars; Grani, Giorgio; Durante, Cosimo; Lamartina, Livia; Trimboli, Pierpaolo; Cantisani, Vito; Department of Radiology
    Background and Objectives: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non‐marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M‐TIRADS score. Materials and Methods: A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound‐guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M‐TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller‐than‐wide shape, metastatic lymph nodes). Non‐marked hypoechoic nodules were classified as TIRADS 3. Results: Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub‐cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M‐TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR—18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M‐TIRADS and Kwak systems—0.9 vs. 0.8, respectively). Accuracy of M‐TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. Conclusions: The non‐marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M‐TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.
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    Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules : A meta-analysis
    (2020-09) Castellana, Marco; Grani, Giorgio; Radzina, Maija; Guerra, Vito; Giovanella, Luca; Deandrea, Maurilio; Ngu, Rose; Durante, Cosimo; Trimboli, Pierpaolo; Department of Radiology
    Objective: Several thyroid imaging reporting and data systems (TIRADS) ha ve been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the Europea n Thyroid Association, namely EU-TIRADS, was the last one to be published. Design: We conducted a meta-analysis to assess the prevalence of malig nancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting mal ignant lesions. Methods: Four databases were searched until December 2019. Original art icles reporting the performance of EU-TIRADS and adopting histology as reference standard were inc luded. The number of malignant nodules in each class and the number of nodules classified as true/false positiv e/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- A nd 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 ma lignancy in class 5. Conclusions: A limited number of studies generally conducted using a retros pective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying th e risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.
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    The role of ceus in the evaluation of thyroid cancer : From diagnosis to local staging
    (2021-09-30) Sorrenti, Salvatore; Dolcetti, Vincenzo; Fresilli, Daniele; Del Gaudio, Giovanni; Pacini, Patrizia; Huang, Pintong; Camponovo, Chiara; Leoncini, Andrea; D’andrea, Vito; Pironi, Daniele; Frattaroli, Fabrizio; Trimboli, Pierpaolo; Radzina, Maija; Cantisani, Vito; Department of Radiology
    Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco‐regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post‐treatment setting.