Background: The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. Method: We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low–moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. Results: We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low–moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low–moderate risk, 21% high risk, and only 0.7% minimal risk. Conclusion: The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.
背景：欧洲甲状腺影像报告与数据系统（EU-TIRADS）旨在通过指导甲状腺结节细针穿刺活检（FNAB）的选择，减少甲状腺癌（TC）的过度诊断。本研究利用国际大型内分泌外科注册数据库EUROCRINE的数据，对EU-TIRADS的结节选择标准进行验证。方法：我们回顾了2020年3月至2022年3月期间接受手术的甲状腺癌患者与良性病变患者的FNAB适应症，同时考虑了术前EU-TIRADS评分及主要结节大小（推荐对5类结节（>10毫米或<10毫米伴可疑淋巴结）、4类结节（>15毫米）和3类结节（>20毫米）进行FNAB）。患者被分为三个风险组：极低风险（甲状腺微小乳头状癌患者）、高风险（pT3b期或更高、pN1b或pM1患者）以及低-中风险（所有其他患者）。我们采用受试者工作特征（ROC）曲线分析评估EU-TIRADS的诊断准确性。结果：我们分析了32,008例手术。约68%的手术记录包含EU-TIRADS分类。EU-TIRADS在高手术量中心展现出诊断准确性，ROC曲线下面积（AUC）中位数为0.752，表明其在识别恶性肿瘤方面具有有效性。在所有病例中，7907例患者为甲状腺癌。值得注意的是，55%的甲状腺癌患者尽管最初不符合EU-TIRADS标准，仍接受了FNAB。这些患者分布在极低风险（58%）、低-中风险（36%）和高风险（5.8%）组别中。在符合FNAB推荐标准的甲状腺癌患者中，78%属于低-中风险，21%为高风险，仅0.7%为极低风险。结论：EU-TIRADS提供了有效的术前恶性肿瘤风险分层。在临床实践中推广EU-TIRADS的正确使用，对于减少低风险甲状腺癌的过度诊断和过度治疗至关重要。
肿瘤(癌症)患者之家