(A301) A Comparative Study on the Performance of Otolaryngologist-Performed Ultrasound in Thyroid Nodule Diagnosis

Introduction: Thyroid nodules are common and require accurate diagnostic strategies. Ultrasound-based risk stratification systems, including the ATA, ACR-TIRADS, K-TIRADS, EU-TIRADS, and our institution's self-developed FEMH Score, are used to assess these nodules. This study evaluates the diagnostic performance of otolaryngologist-performed ultrasound and compares these systems in thyroid nodule risk assessment.

Methods: We conducted a retrospective study from June 2020 to December 2023 at Far Eastern Memorial Hospital in Taiwan. Patients with thyroid nodules who underwent ultrasound-guided FNAC and thyroidectomy (when applicable) were included. We compared the diagnostic performance of the ATA, ACR-TIRADS, K-TIRADS, EU-TIRADS, FEMH Score (>3.3 considered malignant), and FNAC results categorized by the Bethesda System against the final pathology report as the reference standard.

Results: Among 3,328 patients, 128 underwent thyroidectomy with histopathological confirmation. The ATA, ACR-TIRADS, K-TIRADS, and EU-TIRADS showed similar diagnostic performance, with sensitivity ranging from 63% to 66%, specificity from 61% to 64%, and accuracy around 63%-64% (P < 0.01). The FEMH Score demonstrated superior specificity (83.6%), sensitivity of 65.6%, and accuracy of 75.0% (P < 0.01). The Bethesda classification (Category V or VI) showed 100% specificity and 80.5% accuracy (P < 0.01).

Conclusions: The FEMH Score showed superior specificity, making it a valuable tool for distinguishing malignant thyroid nodules. FNAC with Bethesda classification remains highly specific for malignancy, while the FEMH Score can serve as an effective adjunct for early risk assessment. Otolaryngologists can perform ultrasound-based risk stratification with diagnostic performance comparable to that of radiologists or endocrinologists, supporting their growing role in thyroid nodule management.