Review of the British Thyroid Association U classification - a pictorial reference for radiologists in training

Congress:

ECR 2020

Poster Number:

C-12719

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Outcomes, Education and training, Cancer, Outcomes analysis, Education, Ultrasound-Colour Doppler, Ultrasound, Thyroid / Parathyroids, Head and Neck

Authors:

C. McDonnell¹, N. Sheppard¹, M. Courtney², P. Beddy¹; ¹Dublin/IE, ²Dublin 8, Dublin/IE

DOI:

10.26044/ecr2020/C-12719

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-12719

Fig. 3: Nodule demonstrating cystic change and internal colloid (comet-tail artefact)....

Fig. 8: Nodule demonstrating mixed peripheral and internal vascularity, consistent with...

Fig. 9: Thyroid nodule showing disrupted eggshell calcification. Category U4.

Fig. 12: This nodule contains microcalcifications with an irregular outline, and is...

Learning objectives

Our objective is to provide a resource for radiologists, sonographers and those in trainingto use as a reference guide during day-to-day reporting of thyroid ultrasounds. In doing so, we hope to improve the accuracy of stratification of malignancy risk of thyroid nodules when using the BritishThyroidAssociation U Classification.

Background

Ultrasound is the optimal modality for the evaluation and characterisation of clinically apparent thyroid nodules, aswell as the detection of nodules which may be occult on clinical examination. The 2014 British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer, provide guidance for radiologists to classify thyroid nodules based on a defined set of sonographic criteria to stratify risk of malignancy - the U classification, ranging from U1 (benign) to U5 (malignant).[1]This system has been shown to have up to 93.9% accuracy when compared...

Findings and procedure details

The U1-U5 scoring system is based on the sonographic features of thyroid nodules and is used to delineate the likelihood of malignancy and whether FNA should be performed for confirmatory cytology.The followingfeatures are used tocategorise nodules based on their appearances into the U-classification, as described by the British Thyroid Association. Sonographic features suggestive of benignity: A honeycomb or spongiform appearance. Thisis representative ofmicrocystic spaces with thin walls. In order to describe a nodule as "spongiform," over 50% of the nodulemust have this appearance. Nodulesthat are...

Conclusion

In providing this pictorial reference guide, we hope to provide radiologists, sonographers and those in training with a concise and unambiguous guide for applying the BTA U classification while reporting thyroid ultrasounds. If clarity and accuracy of reporting of thyroid nodules on ultrasound imaging can be improved, there will bediscernible benefits for cliniciansand ultimately a significant improvement inpatient care.

Personal information and conflict of interest

C. McDonnell; Dublin/IE - nothing to disclose N. Sheppard; Dublin/IE - nothing to disclose P. Beddy; Dublin/IE - nothing to disclose M. Courtney; Dublin 8, DUBLIN/IE - nothing to disclose

References

Perros P, Boelaert K, Colley S, Evans C, Evans R, Gerrard BA G et al. Guidelines for the management of thyroid cancer. Clinical Endocrinology. 2014;81:1-122. Al-Chalabi H, Karthik S, Vaidyanathan S. Radiological–pathological correlation of the British Thyroid Association ultrasound classification of thyroid nodules: a real-world validation study. Clinical Radiology. 2019;74(9):702-711. 4. Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodules: a pictorial review. Insights into Imaging. 2015;7(1):77-86. Chng C, Tan H, Too C, Lim W, Chiam P, Zhu L et al. Diagnostic...