Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Application of the 2021 Korean Thyroid Imaging Reporting and Data System (K-TIRADS)

2021 한국 갑상선영상 판독과 자료체계의 임상적용

  • Dong Gyu Na (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine)
  • 나동규 (울산대학교 의과대학 강릉아산병원 영상의학과)
  • Received : 2022.11.18
  • Accepted : 2022.01.03
  • Published : 2023.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is a pattern-based, US malignancy risk stratification system that can easily diagnose nodules during real-time ultrasound examinations. The 2021 K-TIRADS clarified the US criteria for nodule classification and revised the size thresholds for nodule biopsy, thereby reducing unnecessary biopsies for benign nodules while maintaining the appropriate sensitivity to detect malignant tumors in patients without feature of high risk thyroid cancer. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care.

갑상선 결절 환자에서 초음파 검사는 일차적 영상 진단법으로 정립되어 있으며 치료 결정을 위한 핵심적인 진단 역할을 갖는다. Korean Thyroid Imaging Reporting and Data System(이하 K-TIRADS)는 초음파 유형에 기초한 암 위험도 분류체계로서 실시간 초음파 검사를 시행하면서 쉽게 결절 진단이 가능하다는 장점을 갖고 있다. 개정된 2021 K-TIRADS는 결절의 초음파 분류 기준을 보다 명확히 하였고, 고위험 갑상선암의 의심 소견이 없는 환자에서 병리진단검사를 결정하는 결절 크기 기준을 개정하여 불필요한 병리진단검사를 최소화하고 적절한 갑상선암 진단 예민도가 유지되도록 개정하였다. 갑상선영상의학진료는 갑상선 결절 환자의 진단 및 비수술적 치료를 수행하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다.

Keywords

References

  1. Ha EJ, Lim HK, Yoon JH, Baek JH, Do KH, Choi M, et al. Primary imaging test and appropriate biopsy methods for thyroid nodules: guidelines by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. Korean J Radiol 2018;19:623-631 
  2. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014;81 Suppl 1:1-122 
  3. 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 
  4. 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 
  5. 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 
  6. 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 
  7. 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 
  8. Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, et al. 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2021;22:2094-2123 
  9. 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 
  10. 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 
  11. 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 
  12. 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 
  13. 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 
  14. 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 
  15. 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 
  16. 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 2021;40:474-485 
  17. Chung SR, Ahn HS, Choi YJ, Lee JY, Yoo RE, Lee YJ, et al. Diagnostic performance of the modified Korean thyroid imaging reporting and data system for thyroid malignancy: a multicenter validation study. Korean J Radiol 2021;22:1579-1586 
  18. Ha EJ, Shin JH, Na DG, Jung SL, Lee YH, Paik W, et al. Comparison of the diagnostic performance of the modified Korean thyroid imaging reporting and data system for thyroid malignancy with three international guidelines. Ultrasonography 2021;40:594-601 
  19. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-691 
  20. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 2005;237:794-800 
  21. 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 
  22. 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 
  23. Reading CC, Charboneau JW, Hay ID, Sebo TJ. Sonography of thyroid nodules: a "classic pattern" diagnostic approach. Ultrasound Q 2005;21:157-165 
  24. Ito Y, Amino N, Yokozawa T, Ota H, Ohshita M, Murata N, et al. Ultrasonographic evaluation of thyroid nodules in 900 patients: comparison among ultrasonographic, cytological, and histological findings. Thyroid 2007;17:1269-1276 
  25. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214 
  26. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009;94:1748-1751 
  27. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 1990;19:545-576 
  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 
  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 
  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 
  31. 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 
  32. 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 
  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 
  34. 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 
  35. 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 
  36. Lee YJ, Kim JY, Na DG, Kim JH, Oh M, Kim DB, et al. Malignancy risk of thyroid nodules with minimal cystic changes: a multicenter retrospective study. Ultrasonography 2022;41:670-677 
  37. Kim JY, Jung SL, Kim MK, Kim TJ, Byun JY. Differentiation of benign and malignant thyroid nodules based on the proportion of sponge-like areas on ultrasonography: imaging-pathologic correlation. Ultrasonography 2015;34:304-311 
  38. 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 
  39. Lee JY, Lee CY, Hwang I, You SH, Park SW, Lee B, et al. Malignancy risk stratification of thyroid nodules according to echotexture and degree of hypoechogenicity: a retrospective multicenter validation study. Sci Rep 2022;12:16587 
  40. Kim SY, Na DG, Paik W. Which ultrasound image plane is appropriate for evaluating the taller-than-wide sign in the risk stratification of thyroid nodules? Eur Radiol 2021;31:7605-7613 
  41. Beland MD, Kwon L, Delellis RA, Cronan JJ, Grant EG. Nonshadowing echogenic foci in thyroid nodules: are certain appearances enough to avoid thyroid biopsy? J Ultrasound Med 2011;30:753-760 
  42. Malhi H, Beland MD, Cen SY, Allgood E, Daley K, Martin SE, et al. Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol 2014;203:1310-1316 
  43. Sohn YM, Na DG, Paik W, Gwon HY, Noh BJ. Malignancy risk of thyroid nodules with nonshadowing echogenic foci. Ultrasonography 2021;40:115-125 
  44. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. New York: Springer International Publishing, 2017 
  45. 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 
  46. Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, et al. Diagnostic algorithm for metastatic lymph nodes of differentiated thyroid carcinoma. Cancers (Basel) 2021;13:1338 
  47. Lee JY, Yoo RE, Rhim JH, Lee KH, Choi KS, Hwang I, et al. Validation of ultrasound risk stratification systems for cervical lymph node metastasis in patients with thyroid cancer. Cancers (Basel) 2022;14:2106 
  48. Paik W, Na DG, Gwon HY, Kim J. CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography. Ultrasonography 2020;39:130-136 
  49. 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 
  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 
  51. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 2015;25:716-759 
  52. Takano T. Overdiagnosis of juvenile thyroid cancer. Eur Thyroid J 2020;9:124-131 
  53. Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, et al. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022;11:e220146 
  54. Kim PH, Yoon HM, Baek JH, Chung SR, Choi YJ, Lee JH, et al. Diagnostic performance of five adult-based us risk stratification systems in pediatric thyroid nodules. Radiology 2022;305:190-198 
  55. Kim PH, Yoon HM, Baek JH, Chung SR, Choi YJ, Lee JH, et al. Diagnostic performance of the 2021 Korean thyroid imaging reporting and data system in pediatric thyroid nodules. Eur Radiol 2023;33:172-180 
  56. Suzuki S, Yamashita S, Fukushima T, Nakano K, Midorikawa S, Ohtsuru A, et al. The protocol and preliminary baseline survey results of the thyroid ultrasound examination in Fukushima. Endocr J 2016;63:315-321 
  57. Lee MK, Na DG, Joo L, Lee JY, Ha EJ, Kim JH, et al. Standardized imaging and reporting for thyroid ultrasound: Korean Society of Thyroid Radiology consensus statement and recommendation. Korean J Radiol 2023;24:22-30