Thyroid cancer - Radiofrequency - Puncture - Diagnosis - Treatment
EU-TIRADS SCORE
The EU TIRADS score Acronym for: European Thyroid Imaging-Reporting and Data System: is a method implemented by the European Thyroid Association in 2017.
The objective of allowing reproducible analysis of thyroid nodules on ultrasound thus allowing better monitoring and better management of patients with thyroid pathology.
The EU TIRADS score is based on two elements: the cardinal signs and the accessory signs.
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Cardinal signs: the presence of a cardinal sign places the nodule in the group EU TIRADS 5 (according to the number of signs_ cardinals the risk varies between 26 and 87%).
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Accessory signs: in the absence of cardinal signs, echogenicity will determine the EU TIRADS 4, 3 and 2 score.
Accessory signs will modulate the risk within each group (cancer risk of 17 – 0%).
This EU-TIRADS system includes:
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A lexicon containing key descriptive words, illustrated with an atlas (“typical” images)
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A score for malignancy risk stratification ranging from 1 to 5
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A standardized report with diagram
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Support recommendations
The EU TIRADS score is based on cardinal signs and accessory signs.
The cardinal signs will classify the nodule in a category and the accessory signs will modulate the risk within each category.
The cardinal signs
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The EU TIRADS 5 score
The cardinal signs of thyroid cancer are four in number:
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The shape of the nodule: not oval, thicker than wide and/or wide.
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The irregular contours of the nodule: spiculated or lobulated.
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The echogenicity of the nodule: marked hypoechogenicity.
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The microcalcifications.
The presence of one of the cardinal signs places the nodule in category 5.
The non-oval nodule shape
The non-oval shape is a suspicious sign so the nodule is classified EU TIRADS 5.
Oval shape
Oval shape
Non-oval shape
Non-oval shape
The irregular contours of the nodule: spicules or lobules
It takes at least three spiculations or three lobulations.
Regular contours
Lobulated contours
Spiculated contours
Lobulated contours
The strong hypoechogenicity
Strong hypoechogenicity
Strong hypoechogenicity
The strong hypoechogenicity of the nodule is a cardinal sign and the hypoechogenicity must be compared to the superficial muscle and not to the healthy thyroid parenchyma.
Microcalcifications
Hyperechoic, rounded or rarely linear pits measuring less than 1 mm in diameter without shadow cone or comet-tail artifact.
It is necessary to take into account their number and their grouping (at least 5).
Do not confuse the microcalcifications with the coloid type images at the level of the nodules.
Microcalcifications
Do not confuse microcalcifications and linear hyperechoic punctuations which have a comet-tail artefact, corresponding to the presence of intra-nodular colloid.
peripheral microcalcifications Documents Dr Laila Daibes Rachid ( colegio Brasileiro de radiologia
peripheral microcalcifications Documents Dr Laila Daibes Rachid ( colegio Brasileiro de radiologia
Macrocalcifications are not specific to malignancy and their presence must be related to the other ultrasound signs present.
The presence of cardinal signs at the level of a nodule means a very high risk of cancer which varies according to the number of signs present between 26% and 87%.
Beware of the fake EU TIRADS 5 score.
It is a highly hypoechoic nodule without any internal vascularization and this aspect is the consequence of the complete resorption of the intra-nodular haemorrhagic liquid component.
False EU-TIRADS 5 score (nodulehemorrhagic with a resorption complete fluid component)
False EU-TIRADS 5 score (nodulehemorrhagic with a resorption complete fluid component)
Accessory signs
Some accessory signs increase the risk of cancer and others decrease the risk.
These signs participate in the modulation of the risk within each EU-TIRADS score without modifying it.
Accessory signs that increase the risk are:
Discontinuous peripheral macrocalcifications
Pathological elastography
Round shape
Central vascularization
Non-parallel orientation
Extra capsular extension
Accessory signs that decrease the risk of malignancy are:
Fine and complete halo
Normal elastography
Peripheral vascularization
Mixed echostructure
colloidal granulation
flattened shape
The vascularization
Controversial value in the literature, vascularization is not retained in the EU TIRADS system.
The vascularization provides few diagnostic arguments, however in isoechoic solid nodules > 20 mm with strong central vascularization, the risk of follicular cancer increases, on the other hand a peripheral vasculature decreases the risk.
Cancerfollicular with strong peripheral and central vascularization
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The EU TIRADS 4 score
Moderately hypoechoic nodule compared to the superficial muscle.
Theoretical risk 6-17%.
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The EU TIRADS 3 score
Hyperechoic or isoechoic nodule.
Theoretical risk 2-4%.
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The EU TIRADS 2 score
Cystic nodule colloidal type or a spongiform type nodule.
Theoretical risk 0%.
The standardized report must include a description of the nodule in 10 points with a diagram.
The standardized report must include a course of action for management.
Multinodular thyroids with the EU TIRADS score.
The strategy consists of:
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Look for high-risk nodules first (EU TIRADS5).
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Look for nodules at intermediate risk (EU TIRADS 4) and describe nodules > 5 mm.
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Look for low-risk nodules (EU TIRADS 3) and describe nodules > 10 mm.
The EU TIRADS score is based on echogenicity.
