Combined Thyroid Imaging Report and Data System Ti-Rads and Ultrasound Guided Fine Needle Aspiration Biopsy in Solid Thyroid Nodules

The aim of this study is to evaluate the utility of UGFNA (ultrasound guided fine needle aspiration biopsy) after evaluating solid thyroid nodules with the risk stratification diagnostic tool, the Thyroid Imaging Reporting and Data System (TI-RADS) classification system. Real time elastography results will be used as one of the six criteria as suspicion for malignancy. The study group comprised 108 cases evaluated by means of ultrasound (Hitachi Preirus Machine, linear multi frequency probe). A pathology report was completed in all cases and considered a diagnostic gold standard. Ultrasound results: TI-RADS 3 (cancer risk < 5%) 3 cases; TI-RADS 4A: 31 cases (cancer risk < 10%), TI-RADS 4B: 50 cases (high risk of malignancy up to 60%); TI-RADS 5: 6 cases (cancer risk > 90%). UGFNA results: 4 cases BETHESDA BI (3.6%) I, 46 cases BII (27.77%), 30 cases BIII (27.77%), 4 cases Bethesda IV (3.70%) and 24 cases BV and VI (22.22%). The pathology certified thyroid cancer in 30 cases: 27 PTC and 3 FTC. Ultrasound evaluation was unclear in TI-RADS 4A and 4B cases (81/108 cases). TI-RADS 2,3 and 5 cases were correctly evaluated by means of TI-RADS. Borderline ultrasound characteristics required further evaluation. TI-RADS 4B cases should be biopsied in order to have a correct approach. The results were that the combination of the two procedures would increase the diagnostic quality, reduce the number of unnecessary UGFNA and would focus on the important lesions to be clarified. However, the TI-RADS model cannot substitute UGFNA.