DOI QR코드

DOI QR Code

Korean Thyroid Imaging Reporting and Data System: Current Status, Challenges, and Future Perspectives

  • Eun Ju Ha (Department of Radiology, Ajou University School of Medicine) ;
  • Dong Gyu Na (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Jung Hwan Baek (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2021.02.02
  • 심사 : 2021.05.02
  • 발행 : 2021.09.01

초록

The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is an ultrasound-based risk stratification system for thyroid nodules that has been widely applied for the diagnosis and management of thyroid nodules since 2016. This review article provides an overview of the use of the K-TIRADS compared with other risk stratification systems. Moreover, this review describes the challenges in the clinical application of the K-TIRADS, as well as future development directions toward the personalized management of patients with thyroid nodules.

키워드

참고문헌

  1. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016;17:370-395
  2. Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, et al. 2016 revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. Int J Thyroidol 2016;9:59-126 https://doi.org/10.11106/ijt.2016.9.2.59
  3. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 2011;12:1-14 https://doi.org/10.3348/kjr.2011.12.1.1
  4. Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid 2016;26:562-572 https://doi.org/10.1089/thy.2015.0460
  5. Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A multicenter prospective validation study for the Korean thyroid imaging reporting and data system in patients with thyroid nodules. Korean J Radiol 2016;17:811-821 https://doi.org/10.3348/kjr.2016.17.5.811
  6. Ha EJ, Na DG, Baek JH, Sung JY, Kim JH, Kang SY. US fine-needle aspiration biopsy for thyroid malignancy: diagnostic performance of seven society guidelines applied to 2000 thyroid nodules. Radiology 2018;287:893-900 https://doi.org/10.1148/radiol.2018171074
  7. Ha EJ, Na DG, Moon WJ, Lee YH, Choi N. Diagnostic performance of ultrasound-based risk-stratification systems for thyroid nodules: comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines. Thyroid 2018;28:1532-1537 https://doi.org/10.1089/thy.2018.0094
  8. Middleton WD, Teefey SA, Reading CC, Langer JE, Beland MD, Szabunio MM, et al. Comparison of performance characteristics of american college of radiology TI-RADS, Korean Society of thyroid radiology TIRADS, and American Thyroid Association guidelines. AJR Am J Roentgenol 2018;210:1148-1154 https://doi.org/10.2214/AJR.17.18822
  9. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: toward the "right" TIRADS. J Clin Endocrinol Metab 2019;104:95-102 https://doi.org/10.1210/jc.2018-01674
  10. Ha SM, Baek JH, Na DG, Suh CH, Chung SR, Choi YJ, et al. Diagnostic performance of practice guidelines for thyroid nodules: thyroid nodule size versus biopsy rates. Radiology 2019;291:92-99 https://doi.org/10.1148/radiol.2019181723
  11. Yoon SJ, Na DG, Gwon HY, Paik W, Kim WJ, Song JS, et al. Similarities and differences between thyroid imaging reporting and data systems. AJR Am J Roentgenol 2019;213:W76-W84 https://doi.org/10.2214/AJR.18.20510
  12. Na DG, Paik W, Cha J, Gwon HY, Kim SY, Yoo RE. Diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy according to nodule size: a comparison with five society guidelines. Ultrasonography 2020 Dec [Epub]. https://doi.org/10.14366/usg.20148
  13. Hayen A, Macaskill P, Irwig L, Bossuyt P. Appropriate statistical methods are required to assess diagnostic tests for replacement, add-on, and triage. J Clin Epidemiol 2010;63:883-891
  14. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133 https://doi.org/10.1089/thy.2015.0020
  15. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract 2016;22:622-639
  16. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017;14:587-595 https://doi.org/10.1016/j.jacr.2017.01.046
  17. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J 2017;6:225-237 https://doi.org/10.1159/000478927
  18. Tessler FN, Middleton WD, Grant EG. Thyroid imaging reporting and data system (TI-RADS): a user's guide. Radiology 2018;287:1082
  19. Na DG, Kim JH, Kim DS, Kim SJ. Thyroid nodules with minimal cystic changes have a low risk of malignancy. Ultrasonography 2016;35:153-158 https://doi.org/10.14366/usg.15070
  20. Lee JY, Na DG, Yoon SJ, Gwon HY, Paik W, Kim T, et al. Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture. Eur Radiol 2020;30:1653-1663 https://doi.org/10.1007/s00330-019-06527-8
  21. Zhou J, Yin L, Wei X, Zhang S, Song Y, Luo B, et al. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS. Endocrine 2020;70:256-279 https://doi.org/10.1007/s12020-020-02441-y
  22. Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography 2016;35:212-219 https://doi.org/10.14366/usg.15074
  23. Gwon HY, Na DG, Noh BJ, Paik W, Yoon SJ, Choi SJ, et al. Thyroid nodules with isolated macrocalcifications: malignancy risk of isolated macrocalcifications and postoperative risk stratification of malignant tumors manifesting as isolated macrocalcifications. Korean J Radiol 2020;21:605-613 https://doi.org/10.3348/kjr.2019.0523
  24. Paik W, Na DG, Gwon HY, Kim J. CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography. Ultrasonography 2020;39:130-136 https://doi.org/10.14366/usg.19045
  25. Yim Y, Na DG, Ha EJ, Baek JH, Sung JY, Kim JH, et al. Concordance of three international guidelines for thyroid nodules classified by ultrasonography and diagnostic performance of biopsy criteria. Korean J Radiol 2020;21:108-116 https://doi.org/10.3348/kjr.2019.0215
  26. Kim PH, Suh CH, Baek JH, Chung SR, Choi YJ, Lee JH. Diagnostic performance of four ultrasound risk stratification systems: a systematic review and meta-analysis. Thyroid 2020;30:1159-1168 https://doi.org/10.1089/thy.2019.0812
  27. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 1990;19:545-576 https://doi.org/10.1016/S0889-8529(18)30310-4
  28. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97:418-428 https://doi.org/10.1016/0002-9343(94)90321-2
  29. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 2005;103:2269-2273 https://doi.org/10.1002/cncr.21055
  30. Nguyen XV, Roy Choudhury K, Tessler FN, Hoang JK. Effect of tumor size on risk of metastatic disease and survival for thyroid cancer: implications for biopsy guidelines. Thyroid 2018;28:295-300 https://doi.org/10.1089/thy.2017.0526
  31. Castellana M, Piccardo A, Virili C, Scappaticcio L, Grani G, Durante C, et al. Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma? Cancer Cytopathol 2020;128:250-259
  32. Hahn SY, Shin JH, Oh YL, Kim TH, Lim Y, Choi JS. Role of ultrasound in predicting tumor invasiveness in follicular variant of papillary thyroid carcinoma. Thyroid 2017;27:1177-1184 https://doi.org/10.1089/thy.2016.0677
  33. Trimboli P, Castellana M, Piccardo A, Romanelli F, Grani G, Giovanella L, et al. The ultrasound risk stratification systems for thyroid nodule have been evaluated against papillary carcinoma. A meta-analysis. Rev Endocr Metab Disord 2021;22:453-460 https://doi.org/10.1007/s11154-020-09592-3
  34. Ito Y, Miyauchi A, Oda H. Low-risk papillary microcarcinoma of the thyroid: a review of active surveillance trials. Eur J Surg Oncol 2018;44:307-315 https://doi.org/10.1016/j.ejso.2017.03.004
  35. Chung SR, Choi YJ, Suh CH, Kim HJ, Lee JJ, Kim WG, et al. Thyroid incidentalomas detected on 18F-fluorodeoxyglucose positron emission tomography with computed tomography: malignant risk stratification and management plan. Thyroid 2018;28:762-768 https://doi.org/10.1089/thy.2017.0560
  36. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Impact of nodule size on malignancy risk differs according to the ultrasonography pattern of thyroid nodules. Korean J Radiol 2018;19:534-541
  37. Park JW, Kim DW, Kim D, Baek JW, Lee YJ, Baek HJ. Korean thyroid imaging reporting and data system features of follicular thyroid adenoma and carcinoma: a single-center study. Ultrasonography 2017;36:349-354 https://doi.org/10.14366/usg.17020
  38. Park KW, Shin JH, Hahn SY, Oh YL, Kim SW, Kim TH, et al. Ultrasound-guided fine-needle aspiration or core needle biopsy for diagnosing follicular thyroid carcinoma? Clin Endocrinol (Oxf) 2020;92:468-474 https://doi.org/10.1111/cen.14167
  39. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Cytology-ultrasonography risk-stratification scoring system based on fine-needle aspiration cytology and the Korean-thyroid imaging reporting and data system. Thyroid 2017;27:953-959 https://doi.org/10.1089/thy.2016.0603
  40. Yang W, Fananapazir G, LaRoy J, Wilson M, Campbell MJ. Can the American Thyroid Association, K-TIRADS and ACRTIRADS ultrasound classification systems be used to predict malignancy in Bethesda category IV nodules? Endocr Pract 2020;26:945-952
  41. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010;102:605-613 https://doi.org/10.1093/jnci/djq099
  42. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med 2016;375:614-617 https://doi.org/10.1056/NEJMp1604412
  43. Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer "epidemic"--screening and overdiagnosis. N Engl J Med 2014;371:1765-1767 https://doi.org/10.1056/NEJMp1409841
  44. Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980-2005. Cancer Epidemiol Biomarkers Prev 2009;18:784-791 https://doi.org/10.1158/1055-9965.EPI-08-0960
  45. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA 2017;317:1338-1348 https://doi.org/10.1001/jama.2017.2719
  46. Seib CD, Sosa JA. Evolving understanding of the epidemiology of thyroid cancer. Endocrinol Metab Clin North Am 2019;48:23-35 https://doi.org/10.1016/j.ecl.2018.10.002
  47. Hoang JK, Nguyen XV, Davies L. Overdiagnosis of thyroid cancer: answers to five key questions. Acad Radiol 2015;22:1024-1029
  48. Malone MK, Zagzag J, Ogilvie JB, Patel KN, Heller KS. Thyroid cancers detected by imaging are not necessarily small or early stage. Thyroid 2014;24:314-318 https://doi.org/10.1089/thy.2012.0651
  49. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid 2016;26:144-149 https://doi.org/10.1089/thy.2015.0178
  50. Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery Task Force on management for papillary thyroid microcarcinoma. Thyroid 2021;31:183-192 https://doi.org/10.1089/thy.2020.0330
  51. Tuttle RM, Fagin JA, Minkowitz G, Wong RJ, Roman B, Patel S, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg 2017;143:1015-1020 https://doi.org/10.1001/jamaoto.2017.1442
  52. Sakai T, Sugitani I, Ebina A, Fukuoka O, Toda K, Mitani H, et al. Active surveillance for T1bN0M0 papillary thyroid carcinoma. Thyroid 2019;29:59-63 https://doi.org/10.1089/thy.2018.0462
  53. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology 2008;247:762-770 https://doi.org/10.1148/radiol.2473070944
  54. Grani G, Lamartina L, Cantisani V, Maranghi M, Lucia P, Durante C. Interobserver agreement of various thyroid imaging reporting and data systems. Endocr Connect 2018;7:1-7 https://doi.org/10.1530/EC-17-0336
  55. Persichetti A, Di Stasio E, Coccaro C, Graziano F, Bianchini A, Di Donna V, et al. Inter-and intraobserver agreement in the assessment of thyroid nodule ultrasound features and classification systems: a blinded multicenter study. Thyroid 2020;30:237-242 https://doi.org/10.1089/thy.2019.0360
  56. Bae JM, Hahn SY, Shin JH, Ko EY. Inter-exam agreement and diagnostic performance of the Korean thyroid imaging reporting and data system for thyroid nodule assessment: real-time versus static ultrasonography. Eur J Radiol 2018;98:14-19
  57. Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, et al. Sonographic assessment of the extent of extrathyroidal extension in thyroid cancer. Korean J Radiol 2020;21:1187-1195 https://doi.org/10.3348/kjr.2019.0983