International Journal of Biomedicine. 2022;12(3):385-390.
Originally published September 5, 2022
Classification of thyroid nodules (TNs) based on TIRADS category is important for predicting malignancy, avoiding unnecessary biopsy and aiding in the management of patients. A prospective nonintervention study was carried out in the period from February 2020 to February 2021 in King Fahad Specialist Hospital in Dammam (Saudi Arabia). The study included 222 patients with suspected TNs (TIRADS 3-5). The thyroid ultrasound scanning was performed with a high frequency linear array probe (9 MHz and 15 MHz). The thyroid gland and adjacent neck tissues were scanned. The diagnostic performance of the TIRADS classifications was evaluated against final histology. Three highly experienced sonographers independently rated the US features of each nodule. Each sonographer assigned points to each TN for the five separate categories (composition, echogenicity, shape, margin, and echogenic foci), according to the TIRADS protocols produced by ACR. Cohen’s kappa scale was used to measure the interobserver agreement in categorizing TNs, and then the performance of ACR TIRADS categories for predicting malignancy was assessed using fine needle aspiration (FNA) as reference standard. For estimation of the diagnostic performance of ACR TIRADS to predict malignancy, the category for each TN was assigned by the principal investigator (Observer 1). This study included only TIRADS 3-5 (mildly to highly suspicious nodules: TR3-TR5), according to ACR TIRADS classification. The agreement for all sonographic features of TN among three observers (principal Observer 1 and two sub-investigators [Observer 2 and Observer 3]) was perfect, being 0.91-1.00 (Cohen’s kappa). Out of 222 patients with TNs, the percentage of malignancy in 68 TIRADS-5 nodules was 91.2%, while in 154 TIRADS 3-4 nodules the percentage of malignancy was 29.9%. The study concluded that interobserver agreement in TIRADS classification and characterization of suspicious thyroid nodule was perfect.
1. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997 Feb 1;126(3):226-31. doi: 10.7326/0003-4819-126-3-199702010-00009.
2. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009 Aug;39(8):699-706. doi: 10.1111/j.1365-2362.2009.02162.x.
3. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004 Oct 21;351(17):1764-71. doi: 10.1056/NEJMcp031436.
4. Mandel SJ. A 64-year-old woman with a thyroid nodule. JAMA. 2004 Dec 1;292(21):2632-42. doi: 10.1001/jama.292.21.2632.
5. Huang S, Meng N, Pan M, Yu B, Liu J, Deng K, Hu M, Zhou H, Qin C. Diagnostic performances of the KWAK-TIRADS classification, elasticity score, and Bethesda System for Reporting Thyroid Cytopathology of TI-RADS category 4 thyroid nodules. Int J Clin Exp Pathol. 2020 May 1;13(5):1159-1168.
6. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009 May;94(5):1748-51. doi: 10.1210/jc.2008-1724.
7. ACR BI-RADS breast imaging and reporting data system: breast imaging atlas. 4th ed. Reston, Va: American College of Radiology, 2003.
8. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017 May;14(5):587-595. doi: 10.1016/j.jacr.2017.01.046.
9. Strigel RM, Burnside ES, Elezaby M, Fowler AM, Kelcz F, Salkowski LR, DeMartini WB. Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI. AJR Am J Roentgenol. 2017 Jun;208(6):1392-1399. doi: 10.2214/AJR.16.16730.
10. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.
11. Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy Risk Stratification of Thyroid Nodules: Comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines. Radiology. 2016 Mar;278(3):917-24. doi: 10.1148/radiol.2015150056.
12. Friedrich-Rust M, Meyer G, Dauth N, Berner C, Bogdanou D, Herrmann E, Zeuzem S, Bojunga J. Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules. PLoS One. 2013 Oct 24;8(10):e77927. doi: 10.1371/journal.pone.0077927.
13. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011 Sep;260(3):892-9. doi: 10.1148/radiol.11110206.
14. García-Moncó Fernández C, Serrano-Moreno C, Donnay-Candil S, Carrero-Alvaro J. Acorrelation study between histological results and thyroid ultrasound findings. The TI-RADS classification. Endocrinol Diabetes Nutr (Engl Ed). 2018 Apr;65(4):206-212. English, Spanish. doi: 10.1016/j.endinu.2017.11.015.
15. Chandramohan A, Abhishek K, Bhari PT, Deepak A, Mj P, Vellore IN et al. Positive predictive value and inter-observer agreement of TI-RADS for ultrasound features of thyroid nodules..ECR 2014. Poster C-0594.
16. Maillo-Nieto AM, Torres TA, Aguirre N, Fernández E, Pla B, Marijuán C. Evaluation of the TIRADS scale in a third level hospital in Andalusia. Endocrinol Nutr. 2016, 1-23.
Received May 14, 2022.
Accepted July 11, 2022.
©2022 International Medical Research and Development Corporation.