ArticleUltrasonography (Seoul, Korea)2018
Use of the ultrasound-based total malignancy score in the management of thyroid nodules.
Article in Ultrasonography (Seoul, Korea), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Sociodemographic and clinical predictors of malignancy in thyroid nodules: a systematic review and meta-analysis.Frontiers in endocrinology · 2026Pooled it
- Clinical significance of isolated macrocalcifications detected by ultrasonography.Ultrasonography (Seoul, Korea) · 2020Article
- Article
- Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art.Gland surgery · 2019Review
- Comparison between ultrasonographic findings and fine needle aspiration cytology in differentiating malignant and benign thyroid nodules.European journal of translational myology · 2019Article
- Use of the ultrasound-based total malignancy score in the management of thyroid nodules.Ultrasonography (Seoul, Korea) · 2019Article
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this study was to validate the role of the total malignancy score (TMS) in identifying thyroid nodules suspicious for malignancy through the sum of their ultrasound features.
methodsThe local ethical committee approved this prospective observational study. We examined 231 nodules in 231 consecutive patients (164 females and 67 males; age range, 20 to 87 years; median age, 59 years; interquartile range, 48 to 70 years) who underwent ultrasound followed by fine-needle aspiration cytology (FNAC). The nodules were further classified using the TMS, which considers ultrasound features (number, echogenicity, structure, halo, margins, Doppler signal, calcifications, and growth), and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), which considers cytological features. Patients with non-negative nodules (TBSRTC categories III to VI) underwent histological analysis, repeated FNAC, or 2 years of regular ultrasound follow-up. The associations between the final diagnosis, each of the ultrasound features, and the TMS were estimated using the chi-square test, the Mann-Whitney U test, and multivariate logistic regression. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the TMS.
resultsOn ultrasound, 47% of the nodules (108 of 231) had a TMS >3, 18% (42 of 231) had a TMS of 3, and 35% (81 of 231) had a TMS >3. The FNAC results of 85% of the nodules (196 of 231) were benign, while 15% (35 of 231) had non-negative results. Hypoechogenicity, solid structure, the presence of microcalcifications, and the number of nodules were independent predictors of the final diagnosis, and the diagnostic accuracy of the TMS was good (area under the ROC curve, 0.82).
conclusionThe TMS system is simple to use, reliable, easily reproducible, and closely reflects malignancy risk. Based on our results, FNAC could be limited to nodules with a TMS ≥3 without missing any cases of carcinoma.
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