MON-461 - Diagnostic Accuracy of Different Guidelines and Ultrasound Scoring Systems for Malignancy Risk Determination of Thyroid Nodules Among Adult Filipinos

Background: Thyroid malignancies are among the most common endocrine malignancies, and in recent years incidence has been shown to be gradually increasing. Among Filipinos, thyroid malignancies have been shown to not only be more common but also exhibit a more aggressive when compared to non-Filipino counterparts which makes early detection vital.

Objectives: This study aims to compare the diagnostic performance of the American Thyroid Association (ATA) guidelines, American College of Radiology (ACR TI-RADS), European Thyroid Association (EU TI-RADS), Korean Society of Thyroid Radiology (K TI-RADS), and Japanese Association of Breast and Thyroid Sonology (JABTS) guidelines in identifying thyroid nodules requiring fine-needle aspiration biopsy (FNAB) among Filipinos.

Methods: This was a single-institution retrospective study in which 508 thyroid nodules from 379 patients were reviewed. Nodules were classified according to the biopsy recommendations of each guideline and compared to their cytopathology results. Nodules were classified as Benign (Bethesda II) vs. Malignant (Bethesda III–VI). Cochran’s Q-test compared overall sensitivities, specificities, and accuracies. McNemar’s test was used for pairwise analysis.

Results: Of the 508 nodules, 212 (41.7%) were malignant.

Sensitivity: There was a significant difference between the sensitivity of the different guidelines (p < 0.001). The most sensitive guidelines were the ATA guidelines (90.57%) and K TI-RADS (90.09%), and pairwise analysis showed that they were significantly more sensitive than the JABTS guidelines (79.72%), EU TI-RADS (71.23%), and ACR TI-RADS (67.92%) (all p < 0.001). There was no significant difference between ATA guidelines and K TI-RADS (p = 1.00).

Specificity: Conversely, the ACR TI-RADS (43.73%) and EU TI-RADS (40.68%) were the most specific. Pairwise analysis showed a significant difference between the ACR TI-RADS and EU TI-RADS when compared to the JABTS (31.19%), K TI-RADS (18.64%), and ATA (17.63%) (all p < 0.001). There was no significant difference between the ACR TI-RADS and the EU TI-RADS (p = 1.00)

Diagnostic Accuracy: There was a significant difference between the diagnostic accuracies of the different guidelines (p = 0.001). The system with the highest diagnostic accuracies were the ACR TI-RADS (53.85%) and EU TI-RADS (53.45%). Pairwise analysis showed significant difference between the ACR TI-RADS when compared to the K TI-RADS (48.52%) and the ATA guidelines (48.13%) (p < 0.05). There was no significant difference between the JABTS guidelines (51.48%) and the other guidelines (p > 0.05).

Conclusion: All guidelines demonstrated the trade-off between sensitivity and specificity. Among Filipinos, where thyroid malignancies exhibit more aggressive behavior, more sensitive systems such as the ATA guidelines and K TI-RADS may be preferable to minimize missed malignancies until population-specific guidelines are developed.

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