TI-RADS Classifiation on the stratification of cancer risk of thyroid nodules and their management

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaThis retrospective study was aimed to evaluate the necessity of US-guided fine-needle aspiration biopsy (FNAB) of Thyroid nodules that were submitted to this technique in the Medical Imaging Department of Coimbra Hospital and Universitary Center (CHUC) during the year of 2013, had it been applied the TI-RADS (Thyroid Imaging Reporting and Data System) classification. From a total sample of 379 patients, only 312 thyroid nodules obtained a conclusive diagnosis (283 benign and 29 malignant), from which 272 were females and 40 were males. Later, each nodule was framed into one of 5 categories of TI-RADS classification, based on the following ecographic characteristics: composition, echogenicity, shape, margin, echogenic foci and dimensions. For the statistical study was used the Chi-square test, t-test of Student, logistic regression and Mann-Whitney U test.Correlating the cytological/histological results of benignity/malignity of the main data base with the use of TI-RADS, a significant statistical relationship (p<0,05) was obtained, relatively to the clinical management between performing an approach with FNAB (fine-needle aspiration biopsy) or ecographic follow-up. It was concluded that 148 (52,3%) aspirations would have been unnecessary and a sensibility of 82,76% and a specificity of 52,29% were achieved in distinguishing benign or malignant nodules, had this system of classification been applied. Therefore, TI-RADS may be useful for the management of the clinical approach of thyroid nodules.Este estudo retrospetivo teve como finalidade avaliar a necessidade da realização de punções aspirativas guiadas por ecografia dos nódulos tiroideus que foram submetidos a esta técnica no Serviço de Imagem Médica do Centro Hospitalar e Universitário de Coimbra (CHUC) durante o ano de 2013, se tivesse sido usada a classificação de TI-RADS (Thyroid Imaging Reporting and Data System). De uma amostra de 379 doentes, obteve-se um diagnóstico conclusivo em 312 (283 nódulos benignos e 29 malignos), sendo 272 do sexo feminino e 40 do masculino. Posteriormente, cada nódulo foi enquadrado em uma das 5 categorias da classificação de TI-RADS, tendo por base as seguintes características ecográficas: composição, ecogenicidade, morfologia, contornos, focos ecogénicos e dimensões. Para o estudo estatístico foi usado o teste do Qui-quadrado, teste t de Student, regressão logística e teste U de Mann-Whitney. Relacionando os resultados citológicos/histológicos de benignidade/malignidade da base de dados com a classificação TI-RADS, obteve-se uma relação estatisticamente significativa (p