Triple diagnostic test in the evaluation of thyroid nodules
DOI:
https://doi.org/10.18203/2349-2902.isj20211309Keywords:
Triple test, Thyroid nodule, McGill, TIRADS, MalignancyAbstract
Background: Thyroid nodules are a common endocrine disease whose prevalence in India is approximately 12.2%. Although most patients with suspected nodules have benign conditions, the overestimation of malignancy leads to the performance of unnecessary procedures. No clinical, radiological and cytological parameters has singularly shown significant impact on clinical practice and post-operative histopathological examination remains the gold standard in the diagnosis of malignancy.
Methods: 55 patients with thyroid nodules were evaluated and the Clinical assessment findings were recorded by McGill thyroid nodule score, ultrasonography findings using TIRADS and FNAC findings by the Bethesda system. The triple test was then used to classify them and these results were compared with the HPE of the post-operative specimen.
Results: The sensitivity and specificity of TIRADS, FNAC were higher as compared to clinical score; clinical score had lowest sensitivity of 72.73%. The sensitivity, specificity, PPV, NPV and accuracy of triple test was 100%. Triple test had higher sensitivity, specificity and accuracy in differentiating thyroid nodules as compared to any of the three parameters used individually.
Conclusions: Triple test has higher accuracy, sensitivity and specificity in determining the nature of thyroid nodule than each of the parameters used individually and it is especially useful in follicular lesions. On the basis of the results of this study, we conclude that the triple test can reliably be used to differentiate benign and malignant nodules preoperatively.
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References
Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003;67(3):559-66.
Zeiger MA, Dackiw AP. Follicular thyroid lesions, elements that affect both diagnosis and prognosis. J Surg Oncol. 2005;89(3):108-13.
De Groot LJ. Multinodular goiter De Groot LJ, editor. (ed). The Thyroid and It's Diseases (3rd ed.). Philadelphia: W.B Saunders Company. 1995;611-33.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, et al. 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.
Renuka IV, SailaBala G, Aparna C, Kumari R, Sumalatha K. The Bethesda System for Reporting Thyroid Cytopathology: Interpretation and Guidelines in Surgical Treatment. Indian Journal of Otolaryngology and Head & Neck Surgery. 2012;64(4):305-311.
Witczak J, Taylor P, Chai J. Predicting malignancy in thyroid nodules: feasibility of a predictive model integrating clinical, biochemical, and ultrasound characteristics. Thyroid Research. 2016;9:4.
Kartini D, Wibisana G. Accuracy of Triple Diagnostic Test in Patients with Thyroid Nodule at Dr. CiptoMangunkusumo General Hospital. E Journal Kedokteran Indonesia. 2017;5(1).
Sands NB, Karls S, Amir A, Tamilia M, Gologan O, Rochon L et al. McGill Thyroid Nodule Score (MTNS): "rating the risk," a novelpredictive scheme for cancer risk determination. J Otolaryngol Head Neck Surg. 2011;40 Suppl 1:S1-13.
Rago T, Fiore E, Scutari M. Male sex, single nodularity and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol. 2010;162:763-70.
Cerci C, Cerci SS, Eroglu E, Dede M, Kapucuoglu N, Yildiz M, et al. Thyroid cancer in toxic and non-toxic multinodular goiter. J Postgrad Med. 2007;53(3):157-60.
Giuffrida D, Gharib H. Controversies in the management of cold, hot and occult thyroid nodules. Am J Med. 1995;99(6):642-50.
Eng CY, Quraishi MS, Bradley PJ. Management of Thyroid nodules in adult patients. Head & Neck Oncology. 2010;2(11):1-5.
Corvilain B. The natural history of thyroid autonomy and hot nodules. Ann Endocrinol (Paris). 2003;64(1):17-22.
Fadda G, Rossi ED, Raffaelli M, Pontecorvi A, Sioletic S, Morassi F, et al. Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and Galectin-3 expression on liquid-based fine-needle cytology. Eur J Endocrinol. 2011;165(3):447-53.
Liu J, Zheng D, Li Q. A predictive model of thyroid malignancy using clinical, biochemical and sonographic parameters for patients in a multi-center setting. BMC Endocrine Disorders. 2018;18:17.