291 Non-invasive imaging biomarkers 3 Table 2. Overview of imaging biomarkers in the management of cytologically indeterminate thyroid nodules exemplified in this chapter Technique Sensitivity Specificity Benign call rate (given a prevalence of 26%) Advantages Drawbacks Costeffectiveness US ATA: 52%* [401] ACR TI-RADS: 70%* [401] EU-TI-RADS: 38%* [401] K-TI-RADS: 78%* [401] *In Bethesda III nodules ATA: 90%* [401] ACR TI-RADS: 60%* [401] EU-TI-RADS: 81%* [401] K-TI-RADS: 53%* [401] *In Bethesda III nodules ATA: 79% ACR TI-RADS: 52% EU TI-RADS: 76% K-RADS: 45% Global availability Low costs No ionising radiation Possibility of US-guided FNAC Operator dependency Limited prospective clinical validation Presumed, but unpublished CT NA NA NA NA Not investigated in indeterminate nodules NA MRI 97%* [439] *In unselected nodules, sensitivity and specificity in indeterminate nodules unknown 95%* [439] NA No ionising radiation High costs Limited evidence No methodological consensus Research ongoing Limited (but increasing) availability of (high-field) MRI scanners Currently unknown [99mTc]Tc-MIBI scintigraphy (WOind) 100%* [447] *Requires preselection of hypofunctioning nodules 89%* [447] 66%* More widely available and lower costs than PET Ionising radiation Limited sensitivity in lesions smaller than 30 mm Unclear [18F]FDG PET/CT 94% [454] 40% [454] 31% [454] High NPV High benign call rate Effective reducing futile diagnostic lobectomies High costs Ionising radiation Limited but increasing availability of scanners and radiotracers Incidental findings (low specificity) Reduced the lifelong societal costs by almost €10,000 as compared to diagnostic surgery [460]
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