Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

ATA Sonographic Patterns Stratify Cancer Risk

Thyroid; ePub 2018 Jul 17; Valderrabano, et al

American Thyroid Association (ATA) sonographic patterns are associated with distinct clinical features and pathological outcomes, and effectively stratify the cancer risk in indeterminate thyroid nodules (ITNs), a recent study found. Thus, the ATA sonographic patterns should be used not only to set the size threshold for biopsy, but also to personalize management after the biopsy. Ultrasound images of 463 ITNs (38% atypia/follicular lesions of undetermined significance; 62% follicular neoplasms) with histological follow-up consecutively evaluated between October 2008 and June 2015 at an academic cancer center were independently evaluated by 3 observers and classified into 1 of the 5 sonographic patterns proposed by the ATA. They found:

  • The distribution of size and cytological diagnosis was significantly different between sonographic patterns.
  • The overall rate of malignancy was 27%.
  • The rate of malignancy for the very low, low/intermediate, high, and non-ATA patterns were 0%, 19%, 56%, and 36%, respectively, and were all significantly different.
  • Compared to the low/intermediate suspicion patterns, the odds ratios for malignancy were 2.35 for the non-ATA and 5.18 for the high suspicion patterns.


Valderrabano P, McGettigan MJ, Lam CA, et al. Thyroid nodules with indeterminate cytology: Utility of the American Thyroid Association sonographic patterns for cancer risk stratification. [Published online ahead of print July 17, 2018]. Thyroid. doi:10.1089/thy.2018.0085.

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