ACR Thyroid Imaging Reporting And Data System Research Articles

Revised Thyroid Imaging Reporting and Data System (TIRADS): imitating the American College of Radiology TIRADS, a single-center retrospective study.

The incidence of thyroid lumps is more and more high in population, and most biopsies of thyroid nodules are benign. To develop a practical risk stratification system based on five ultrasound features to stratify the malignancy risk of thyroid neoplasms. This retrospective investigation enrolled 999 consecutive patients with 1,236 thyroid nodules who underwent ultrasound screening. Fine-needle aspiration and/or surgery was performed, and pathology results were obtained at the Seventh Affiliated Hospital of Sun Yat-sen University in Shenzhen, China, which is a tertiary referral center, from May 2018 to February 2022. Each thyroid nodule's score was calculated based on five ultrasound features: composition, echogenicity, shape, margin, and echogenic foci. Additionally, each nodule's malignancy rate was calculated. The chi-square test was used to test whether the malignancy rate was different among the three subcategories (scores of 4-6, 7-8, and 9 or more) of thyroid nodules. We proposed the revised Thyroid Imaging Reporting and Data System (R-TIRADS), and its sensitivity and specificity were compared to the two existing systems [the American College of Radiology TIRADS (ACR TIRADS) and the Korean Society of Thyroid Radiology TIRADS (K-TIRADS)]. The final dataset consisted of 425 nodules from 370 patients. The malignancy rates of three subcategories [malignancy rate: 28.8% (scores from 4-6), 64.7% (scores from 7-8), and 84.2% (scores of 9 or more)] were significantly different (P<0.01). The unnecessary biopsy rates of the three systems (ACR TIRADS, R-TIRADS, and K-TIRADS) were 28.7%, 25.2%, and 14.8%, respectively. The R-TIRADS presented better diagnostic performance than the ACR TIRADS or K-TIRADS [area under the curve: 0.79 (95% CI: 0.74-0.83) vs. 0.69 (95% CI: 0.64-0.75), P=0.046; 0.79 (95% CI: 0.74-0.83) vs. 0.66 (95% CI: 0.60-0.71), P=0.041, respectively]. The R-TIRADS had the highest sensitivity [0.746 (95% CI: 0.689-0.803)], followed by the K-TIRADS [0.399 (95% CI: 0.335-0.463), P=0.000] and ACR TIRADS [0.377 (95% CI: 0.314-0.441), P=0.000]. The R-TIRADS enables radiologists to diagnose thyroid nodules efficiently, and the number of unnecessary fine-needle aspirations can be considerably reduced.

Multimodal ultrasound imaging: A method to improve the accuracy of diagnosing thyroid TI-RADS 4 nodules.

Thyroid nodule is a common and frequently occurring disease in the neck in recent years, and ultrasound has become the preferred imaging diagnosis method for thyroid nodule due to its advantages of noninvasive, nonradiation, real-time, and repeatable. The thyroid imaging, reporting and data system (TI-RADS) classification standard scores suspicious nodules that are difficult to determine benign and malignant as grade 4, and further pathological puncture is recommended clinically, which may lead to a large number of unnecessary biopsies and operations. Including conventional ultrasound, ACR TI-RADS, shear wave elastography, super microvascular imaging, contrast enhanced ultrasound, "firefly," artificial intelligence, and multimodal ultrasound imaging used in combination. In order to identify the most clinically significant malignant tumors when reducing invasive operations. This article reviews the application and research progress of multimodal ultrasound imaging in the diagnosis of TI-RADS 4 thyroid nodules.

Comparison of thyroid nodule FNA rates recommended by ACR TI-RADS, Kwak TI-RADS and ATA guidelines

ObjectivesTo compare the differences among the thyroid imaging reporting and data system (TI-RADS) proposed by American College of Radiology (ACR TI-RADS), TI-RADS proposed by Kwak (Kwak TI-RADS), and American Thyroid Association (ATA) guidelines in the specificity, sensitivity and the unnecessary FNA rate (the UFR, the false positive rate) of recommended fine needle aspiration (FNA), and to observe the changes of the UFR in the KwakTI-RADS and ATA guidelines with the recommended FNA nodule size threshold. MethodsThe specificities, sensitivities and UFRs of recommended FNA in the ACR TI-RADS, ATA guidelines and Kwak TI-RADS were calculated and compared. The nodule sizes for recommended FNA of ATA guidelines and Kwak TI-RADS were systematically varied to establish new FNA thresholds. The specificities, sensitivities and UFRs of recommended FNA under the new models were calculated and compared to those in the ACR TI-RADS. ResultsFor all thyroid nodules, the UFRs in the ACR TI-RADS, ATA guidelines and Kwak TI-RADS were 26.3%, 47.4% and 40.0%, respectively. The UFR in the ACR TI-RADS was lower than that in the others, and the specificity of recommended FNA in the ACR TI-RADS(73.7%) was higher than that in the others (all P < 0.001), but the sensitivity of recommended FNA in the ACR TI-RADS(89.3%) was lower than that in the others (all P < 0.001). When nodule sizes threshold of the recommended FNA for ATA guidelines Intermediate Suspicion, Low Suspicion, and Very Low Suspicion, and Kwak TI-RADS grade 4b and 4a were gradually increased, the UFRs gradually decreased. ConclusionsThe UFRs of FNA recommended by the Kwak TI-RADS and ATA guidelines were higher than that of the ACR TI-RADS, and were affected by the recommended FNA nodule size threshold.

Diagnostic value of 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) combined with fine needle aspiration biopsy in thyroid nodules

To evaluate diagnostic value of Thyroid Imaging Reporting and Data System published by American College of Radiology (ACR TI-RADS) in 2017, ultrasound-guided fine-needle aspiration (US-FNA), and the combination of both methods in differentiation between benign and malignant thyroid nodules. The data of US-FNA and ACR TI-RADS are collected from 159 patients underwent thyroid surgery in our hospital, which include a total of 178 thyroid nodules. A Bethesda System for Reporting Thyroid Cytopathology category of ≥IV and an ACR TI-RADS category ≥4 are regarded as diagnosis standards for malignancy in US-FNA and ACR TI-RADS, respectively. The pathological results after surgery are considered as the gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ACR TI-RADS, US-FNA and the combination of both methods for the differential diagnosis of thyroid nodules are calculated, respectively. The sensitivity, specificity and accuracy of ACR TI-RADS are 85.4%, 37.5%and 72.5%, respectively. The sensitivity, specificity and accuracy of US-FNA are 70.0%, 100%and 78.1%, respectively. After combining these two methods, the sensitivity, specificity and accuracy increase to 99.23%, 37.50%and 82.58%, respectively. The sensitivity of ACR TI-RADS is higher than that of US-FAN, and the sensitivity of combining these two methods is also higher than that of using ACR TI-RADS and US-FNA alone. The established ACR TI-RADS can help in selecting the target during nodule puncture, while the combination of ACR TI-RADS and US-FAN can further improve diagnostic ability for detecting malignant thyroid nodules.

Comparison of the Diagnostic Performance of Ultrasound-Based Thyroid Imaging Reporting and Data System (TIRADS) Classification with American Thyroid Association (ATA) Guidelines in the Prediction of Thyroid Malignancy in a Single Tertiary Center in Manila, Philippines.

ObjectiveTo compare the diagnostic performance of American College of Radiology-Thyroid Image Reporting and Data Systems (ACR-TIRADS) and the American Thyroid Association (ATA) guidelines on screening for thyroid malignancy.MethodologyA cross-sectional criterion-referenced study involving Filipino patients with thyroid nodules, 18-80 years old, who underwent ultrasound guided fine needle aspiration biopsy at the Thyroid Clinic of The Medical City from July to December 2019. The ACR-TIRADS and the ATA guidelines were compared for 197 nodules. Standard diagnostic parameters were calculated, namely sensitivity, specificity, PPV, NPV, positive and negative likelihood ratios and overall accuracies.ResultsThe risks of malignancy were 15% and 22% for TIRADS 4 and 5 respectively. For ATA guidelines, it’s 2%, 20%, and 15% for nodules with low, intermediate, and high suspicion respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) in relation to Fine Needle Aspiration Cytology (FNAC) is 100%, 52.2%, 16.5%, 100%, and 56.4% respectively. For the American Thyroid Association (ATA) guidelines it is 88.2%, 57.8%, 16.5%, 98.1%, and 60.4% respectively.ConclusionThe ACR TIRADS classifications appears to be more sensitive than the ATA classification. The ATA guidelines prove to be a more specific test. Each tool has its unique advantages and disadvantages. Therefore, clinicians must use these tools with utmost vigilance to avoid over or under diagnosis and to avoid unnecessary thyroid nodule biopsies.

Risk Stratification of 18F-Fluorodeoxyglucose-Avid Thyroid Nodules Based on ACR Thyroid Imaging Reporting and Data System.

Fine needle aspiration (FNA) of thyroid nodules is often requested based on 18F-fluorodeoxyglucose (FDG) uptake regardless of sonographic features. The purpose of this study is to determine the risk of malignancy in FDG-avid thyroid nodules when stratified according to the ACR Thyroid Imaging Reporting and Data System (TI-RADS). This retrospective study included patients who underwent ultrasound-guided FNA between January 1, 2010, and November 19, 2018, and PET/CT within 1 year before the FNA. In all, 170 nodules in 166 patients (65 men, 101 women, age 60.2 ± 14.3 years) were eligible for inclusion, of which 151 had a clearly benign or malignant histology. PET images were reviewed for maximum standardized uptake value and nodule location. Sonographic features and TI-RADS category were determined by three radiologists. Patient charts were reviewed for histology. Statistical analyses included risk of malignancy in FDG-avid nodules within each TI-RADS category. Of the 151 nodules, 52 were malignant (34.4%). Malignancy risk was 0% in 1 TR1 nodule (compared with 0.3% in the published TI-RADS study), 16.7% in 6 TR2 nodules (compared with 1.5%), 13.2% in 38 TR3 nodules (compared with 4.8%), 23.7% in 59 TR4 nodules (compared with 9.1%), and 68.1% in 47 TR5 nodules (compared with 35.0%). The majority (71%, 121 of 170) of FDG-avid thyroid nodules are TR4 and TR5, with rates of malignancy greater than those in the general TI-RADS population. ACR TI-RADS is helpful in stratification of FDG-avid nodules; the risk of malignancy in sonographically low-suspicion nodules (13.3%, 6 of 45) is significantly lower than high-suspicion nodules (43.4%, 46 of 106, P < .001).

A practical trial to use Thyroid Imaging Reporting and Data System (TI-RADS) in differentiation between benign and malignant thyroid nodules

BackgroundThyroid nodules have been reported up to 68% in adults using ultrasound examination. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is founded on the evaluation of ultrasound (US) features in five categories: composition, echogenicity, shape, margin, and echogenic foci; the nodule’s total points determine its risk level, which ranges from TI-RADS1 (TR1) (benign) to TI-RADS5 (TR5) (highly suspicious). In conjunction with the nodule’s maximum diameter, the TR level determines whether to recommend a fine-needle aspiration (FNA) biopsy, a follow-up US examination, or no further action; our aim in this study was to apply ACR TI-RADS as a method for discrimination between benign and malignant nodules.MethodsWe applied ACR TI-RADS template for 40 thyroid nodules, the total points given to thyroid nodules ranged from 0 to 14 points, then we compared our results with scintigraphy, fine-needle aspiration cytology (FNAC), and histopathological reports after surgery.ResultsOf 40 thyroid nodules, 31 nodules (77.5%) were benign and 9 nodules (22.5%) were malignant; there was a statistically high significant trend of increasing risk of malignancy as the final TI-RADS level increased from TR1 to TR5 (P value < 0.001).ConclusionThe ACR TI-RADS scoring system is a simple easy method to be applied in daily ultrasound practice; it has an excellent diagnostic accuracy for the diagnosis of malignant thyroid nodules in the present study, as the aggregate risk of malignancy increased as the TI-RADS level increases from TR1 to TR5.

Efficiency comparison of Kwak and ACR (2017) Thyroid Imaging Reporting and Data System(TI-RADS) classification: a polycentric retrospective study

Objective To evaluate the diagnostic efficacy of Kwak and ACR(2017) thyroid imaging reporting and data systems(TI-RADS) for thyroid nodules. Methods Cases of thyroid nodule who underwent surgery from January 2015 to March 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR TI-RADS classification methods. Totally, 12 712 thyroid nodules were observed, 7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study. Thyroid nodules with solid, hypoechoic or very hypoechoic, tall/wide ratio ≥1, margin ill-defined and microcalcification were classified as malignant signs of ultrasound. Malignant percentage was calculated and diagnostic tests were performed. Results ①There was a statistical difference between the benign and malignant nodules in the two types of TI-RADS classification (P<0.01). ②The area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0.89 and 0.84, respectively. The Youden index of Kwak and ACR were 0.66 and 0.57, respectively. ③Taking Kwak TI4B and ACR TR4 as critical points for malignancy, the sensitivity, specificity, positive predictive value and negative predictive value of Kwak TI4B were 75.0%, 90.9%, 83.2%, and 85.9%, respectively. The accuracy of Kwak TI4B was 84.9%; The sensitivity, specificity, positive predictive value and negative predictive value of ACR TR4 were 88.2%, 68.9%, 62.9%, and 90.8%, respectively. The accuracy of ACR TR4 was 76.2%. The Kappa value of Kwak TI4B and ACR TR4 was 0.52. The χ2 value of Kwak TI4B and ACR TR4 was 2 174.6 (P<0.01). Conclusions The diagnostic values of two TI-RADS classification methods for thyroid malignant nodules are high. The overall efficiency of Kwak TI-RADS classification method is better than that of ACR TI-RADS classification method. Key words: Ultrasonography; Thyroid nodule; Thyroid imaging reporting and data system; Kwak TI-RADS; ACR TI-RADS; Diagnostic efficiency