AMERICAN COLLEGE OF RADIOLOGY THYROID IMAGING REPORTING AND DATA SYSTEM IN SOLITARY THYROID NODULES – A COMMUNITY-BASED SINGLE CENTRE REAL WORLD EXPERIENCE

Abstract

Introduction: A solitary thyroid nodule (STN) is a palpable enlargement in a normally functioning thyroid. Diagnosing and treating STN requires a holistic approach. Ultrasonography (USG) is a standard screening tool to identify high-risk nodules that may require fine needle aspiration cytology (FNAC) (benign/malignant). Hence, the current analysis aimed to access the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) with the malignancy and the management of STN in routine clinical practice. Methods: The study was a retrospective analysis of STN patients electronic medical records (EMR) database and USG recorded from 2014 to 2022. We queried a single-center EMR database with the search terms “solitary thyroid nodule”, “autonomously functioning thyroid nodule” and “nontoxic multinodular goiter”. A total of 213 records were identified with STN diagnosis, 161 records have one USG report, and of which a 5-year follow-up of 88 records having at least 2 USG reports with at least 1-year time interval of follow-up data. To better identify benign and malignant nodules and optimize clinical management, ACR-TIRADS and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was adapted in clinic from 2017. Descriptive statistics was used to report the statistical analysis of data. Results: A total of 213 patients were identified with STN. The mean (SD) age is 45.2 (13.8) years. Of these, majority were female, 158 (75%) than male, 54 (25%). Of the total of 160 patients who had ACR TIRADs, 2 (1%) patients had score of 1, 97 (67%) had score 2, 46 (26%) had score 3, 16 (10%) had score 4, 3 (2%) had score 5. Ninety six (45%) patients had Bethesda categorization of nodule and it is observed in 3 (3%), 82 (82%), 8 (8%), 2 (2%), 1 (1%) belonged to class 1, 2, 3, 4, 5, respectively. At follow-up, 67 (76%) patients had no change in the ACR TIRAD nodule score, in 14 (16%) patients score decreased and in 7 (8%) patients increase in score. At baseline the mean (median) nodular volume is 24.2 (8.2) and at follow up 22.2 (6.7), percent change in the nodule volume is -17.7% (-16.0%). Further, of the 88 patients, 7 (9%) of patients had shown >50% increase in the nodular volume. Conclusion: In this real-world data analysis of STN, we observed that the majority of the nodules are benign and nonprogressive, and very few patients had the risk of malignancy, indicating better treatment approaches to control the progression of this condition.