Stratification of the Oncological Risk of Thyroid Nodules: Historical Background and the Current State of the Issue

Objective. Evaluation of existing approaches to cancer risk stratification of thyroid nodules based on ultrasound data.

Materials and Methods. The study of literature data in the historical aspect, modern scientific publications, specialized clinical protocols and consensuses.

Results. Currently, there are many scales that are similar or close in name, but differ fundamentally in the methods of evaluation («ultrasound models», algorithms, number of cancer signs, scores, etc.), the number and value of categories and subcategories, and the recommendations made. The most famous among them are: TIRADS – E. Horvath et al. (Chile, 2009), which includes 6 categories, including 2 subcategories; THIRADS – A. D. Zubov et al. (currently in Russia, 2010): 5 categories, including 2 subcategories; TIRADS – Jin Kwak et al. (Republic of Korea, 2011): 5 categories, including 3 subcategories; TIRADS – G. Russ et al. (France, 2011): 7 categories, including 3 subcategories; ACR TI-RADS – (USA, 2017): 5 categories; EU-TIRADS (international group, 2017): 5 categories; TI-RADS (Russia, 2020): 6 categories. It has been established that at the present stage, clinicians (oncologists, endocrinologists) do not have sufficient information about the diversity of existing stratification scales. This has led to ambiguity of wording and incorrect references in current clinical recommendations and other regulatory documents defining the use of a particular stratification scale. Practitioners doctors of ultrasound diagnostics in the vast majority of cases do not indicate or incorrectly indicate the stratification scale used. Since the same figure in different scales may indicate clinically different situations, missing, incorrect or ambiguous indication may lead to errors in cancer risk assessment and patient management.

Conclusion. Thus, unification and standardization of the used stratification scales is necessary to ensure mutual understanding of specialists and to exclude different interpretations of ultrasound conclusions. The obligation to use a single scale at all stages of the treatment and diagnostic process by all specialists in all regions, and the indication of which one, should be correctly and unambiguously defined in all relevant regulatory documents.

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