EU-TIRADS-Based Omission of Fine-Needle Aspiration and Cytology from Thyroid Nodules Overlooks a Substantial Number of Follicular Thyroid Cancers

Table 2

Evaluation of nodular goiter based on the 2006 Guideline of the AACE/ACE and on the EU-TIRADS in relation to missing the cancer diagnosis in three subtypes of thyroid cancers.

Maximal diameter of the nodule	Indication of FNA
	≤10 mm	10 mm–20 mm	>20 mm
AACE/ACE guideline (2006)	Suspicious lesion	All nodules	All nodules
EU-TIRADS (2017)	If equivocal^1	Depending on the EU-TIRADS score	All nodules^2
Overlooked carcinomas by EU-TIRADS (% of all cancers of that type irrespective of nodule size)	6.7% of FTC^3	13.3% of FTC	None
	4.3% of MTC^3	4.3% of MTC	None
	28.5% of PTC^3	5.2% of PTC	None
Overlooked carcinomas by EU-TIRADS (% of cancers within the specific size limits)	100% of FTC^3	44.4% of FTC	None
	100% of MTC^3	11.1% of MTC	None
	100% of PTC^3	15.0% of PTC	None
Inaccuracy of FNA: nondiagnostic and false-negative results (related to all cancers of that type)	3.3% of FTC	0% in FTC	3.3% of FTC
	0% of MTC	4.3% of MTC	0% in MTC
	1.8% of PTC	3.2% of PTC	5.0% of PTC

EU-TIRADS, Thyroid Imaging Reporting and Data System of the European Thyroid Association [8]; AACE/ACE, American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) [2]. ¹EU-TIRADS suggests “FNA or active surveillance.” ²Except for pure cysts and entirely spongiform cysts. ³Overlooked if FNA would not have been performed in suspicious lesions ≤10 mm.