ACR TI-RADS Research Articles

Assessment of the Diagnostic Performance of a Commercially Available Artificial Intelligence Algorithm for Risk Stratification of Thyroid Nodules on Ultrasound.

Background: Thyroid nodules are challenging to accurately characterize on ultrasound (US), though the emergence of risk stratification systems and more recently artificial intelligence (AI) algorithms has improved nodule classification. The purpose of this study was to evaluate the performance of a recent Food and Drug Administration (FDA)-cleared AI tool for detection of malignancy in thyroid nodules on US. Methods: One year of consecutive thyroid US with ≥1 nodule from Duke University Hospital and its affiliate community hospital (649 nodules from 347 patients) were retrospectively evaluated. Included nodules had ground truth diagnoses by surgical pathology, fine needle aspiration (FNA), or three-year follow-up US showing stability. An FDA-cleared AI tool (Koios DS Thyroid) analyzed each nodule to generate (i) American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) descriptors, scores, and follow-up recommendations and (ii) an AI-adapter score to further adjust risk assessments and recommendations. Four groups were then compared: (i) Koios with AI-adapter, (ii) Koios without AI-adapter, (iii) clinical radiology report, and (iv) radiology report combined with AI-adapter. Performance of the final recommendations (FNA or no FNA) was determined based on ground truth, and comparison between the four groups was made using sensitivity, specificity, and receiver-operating-curve analysis. Results: Of 649 nodules, 32 were malignant and 617 were benign. Performance of Koios with AI-adapter enabled was similar to radiologists (area under the curve [AUC] 0.70 for both, [CI 0.60-0.81] and [0.60-0.79], respectively). Koios with AI-adapter had improved specificity compared to radiologists (0.63 [CI: 0.59-0.67] versus 0.43 [CI: 0.38-0.48]) but decreased sensitivity (0.69 [CI: 0.50-0.83) versus 0.81 [CI: 0.61, 0.92]). Highest performance was seen when the radiology interpretation was combined with the AI-adapter (AUC 0.76, [CI: 0.67-0.85]). Combined with the AI-adapter, radiologist specificity improved from 0.43 ([CI: 0.38-0.48]) to 0.53 ([CI: 0.49-0.58]) (McNemar's test p < 0.001), resulting in 17% fewer FNA recommendations, with unchanged sensitivity (0.81, p = 1). Conclusion: Koios DS demonstrated standalone performance similar to radiologists, though with lower sensitivity and higher specificity. Performance was best when radiologist interpretations were combined with the AI-adapter component, with improved specificity and reduced unnecessary FNA recommendations.

Predicting papillary thyroid microcarcinoma in American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) 3 nodules: radiomics analysis based on intratumoral and peritumoral ultrasound images.

A subset of patients undergoing thyroid surgery for presumed benign thyroid disease presented with papillary thyroid microcarcinoma (PTMC). A non-invasive and precise method for early recognition of PTMC are urgently needed. The aim of this study was to construct and validate a nomogram that combines intratumoral and peritumoral radiomics features as well as clinical features for predicting PTMC in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) 3 nodules using ultrasonography. A retrospective review was conducted on a cohort of 221 patients who presented with ACR TI-RADS 3 nodules. These patients were subsequently pathologically diagnosed with either PTMC or benign thyroid nodules. These patients were randomly divided into a training and test cohort with an 8:2 ratio for developing the clinical model, intratumor-region model, peritumor-region model and the combined-region model respectively. The radiomics features were extracted from ultrasound (US) images of each patient. We employed K-nearest neighbor (KNN) model as the base model for building the radiomics signature and clinical signature. Finally, a radiomics-clinical nomogram that combined intratumoral and peritumoral radiomics features as well as clinical features was developed. The prediction performance of each model was assessed by the area under the curve (AUC), sensitivity, specificity and calibration curve. A total of 23 radiomics features were selected to develop radiomics models. The combined-region radiomics model showed favorable prediction efficiency in both the training dataset (AUC: 0.955) and the test dataset (AUC: 0.923). A radiomics-clinical nomogram was constructed and achieved excellent calibration and discrimination, which yielded an AUC value of 0.950, a sensitivity of 0.950 and a specificity of 0.920. This study proposed the nomogram that contributes to the accurate and intuitive identification of PTMC in ACR TI-RADS 3 nodules.

Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study.

This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

A fully autonomous robotic ultrasound system for thyroid scanning

The current thyroid ultrasound relies heavily on the experience and skills of the sonographer and the expertise of the radiologist, and the process is physically and cognitively exhausting. In this paper, we report a fully autonomous robotic ultrasound system, which is able to scan thyroid regions without human assistance and identify malignant nod- ules. In this system, human skeleton point recognition, reinforcement learning, and force feedback are used to deal with the difficulties in locating thyroid targets. The orientation of the ultrasound probe is adjusted dynamically via Bayesian optimization. Experimental results on human participants demonstrated that this system can perform high-quality ultrasound scans, close to manual scans obtained by clinicians. Additionally, it has the potential to detect thyroid nodules and provide data on nodule characteristics for American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) calculation.

Improved cancer risk stratification of isoechoic thyroid nodules to reduce unnecessary biopsies using quantitative ultrasound.

Gray-scale ultrasound (US) is the standard-of-care for evaluating thyroid nodules (TNs). However, the performance is better for the identification of hypoechoic malignant TNs (such as classic papillary thyroid cancer) than isoechoic malignant TNs. Quantitative ultrasound (QUS) utilizes information from raw ultrasonic radiofrequency (RF) echo signal to assess properties of tissue microarchitecture. The purpose of this study is to determine if QUS can improve the cancer risk stratification of isoechoic TNs. Patients scheduled for TN fine needle biopsy (FNB) were recruited from the Thyroid Health Clinic at Boston Medical Center. B-mode US and RF data (to generate QUS parameters) were collected in 274 TNs (163 isoechoic, 111 hypoechoic). A linear combination of QUS parameters (CQP) was trained and tested for isoechoic [CQP(i)] and hypoechoic [CQP(h)] TNs separately and compared with the performance of conventional B-mode US risk stratification systems. CQP(i) produced an ROC AUC value of 0.937+/- 0.043 compared to a value of 0.717 +/- 0.145 (p >0.05) for the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) and 0.589 +/- 0.173 (p >0.05) for the American Thyroid Association (ATA) risk stratification system. In this study, CQP(i) avoids unnecessary FNBs in 73% of TNs compared to 55.8% and 11.8% when using ACR TI-RADS and ATA classification system. This data supports that a unique QUS-based classifier may be superior to conventional US stratification systems to evaluate isoechoic TNs for cancer and should be explored further in larger studies.

Dual-modal radiomics nomogram based on contrast-enhanced ultrasound to improve differential diagnostic accuracy and reduce unnecessary biopsy rate in ACR TI-RADS 4–5 thyroid nodules

BackgroundAmerican College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS, TR) 4 and 5 thyroid nodules (TNs) demonstrate much more complicated and overlapping risk characteristics than TR1-3 and have a rather wide range of malignancy possibilities (> 5%), which may cause overdiagnosis or misdiagnosis. This study was designed to establish and validate a dual-modal ultrasound (US) radiomics nomogram integrating B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) imaging to improve differential diagnostic accuracy and reduce unnecessary fine needle aspiration biopsy (FNAB) rates in TR 4–5 TNs.MethodsA retrospective dataset of 312 pathologically confirmed TR4-5 TNs from 269 patients was collected for our study. Data were randomly divided into a training dataset of 219 TNs and a validation dataset of 93 TNs. Radiomics characteristics were derived from the BMUS and CEUS images. After feature reduction, the BMUS and CEUS radiomics scores (Rad-score) were built. A multivariate logistic regression analysis was conducted incorporating both Rad-scores and clinical/US data, and a radiomics nomogram was subsequently developed. The performance of the radiomics nomogram was evaluated using calibration, discrimination, and clinical usefulness, and the unnecessary FNAB rate was also calculated.ResultsBMUS Rad-score, CEUS Rad-score, age, shape, margin, and enhancement direction were significant independent predictors associated with malignant TR4-5 TNs. The radiomics nomogram involving the six variables exhibited excellent calibration and discrimination in the training and validation cohorts, with an AUC of 0.873 (95% CI, 0.821–0.925) and 0.851 (95% CI, 0.764–0.938), respectively. The marked improvements in the net reclassification index and integrated discriminatory improvement suggested that the BMUS and CEUS Rad-scores could be valuable indicators for distinguishing benign from malignant TR4-5 TNs. Decision curve analysis demonstrated that our developed radiomics nomogram was an instrumental tool for clinical decision-making. Using the radiomics nomogram, the unnecessary FNAB rate decreased from 35.3 to 14.5% in the training cohort and from 41.5 to 17.7% in the validation cohorts compared with ACR TI-RADS.ConclusionThe dual-modal US radiomics nomogram revealed superior discrimination accuracy and considerably decreased unnecessary FNAB rates in benign and malignant TR4-5 TNs. It could guide further examination or treatment options.

The value of quantitative and a new qualitative color pattern shear wave elastography for the differentiation of ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm.

This study aims to evaluate the diagnostic performance of quantitative shear wave elastography (SWE) and a new qualitative color pattern SWE for the differentiation of benign and malignant American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR TI-RADS) 4 or 5 category thyroid nodules measuring ≤10 mm. From May 2020 to July 2022, a total of 237 patients with 270 thyroid nodules were enrolled, and conventional ultrasound and SWE examinations were performed for each patient. Each ACR TI-RADS 4 or 5 category thyroid nodule measuring ≤10 mm was evaluated by quantitative SWE and a new qualitative color pattern SWE. The diagnostic performance of quantitative SWE parameters, the new qualitative color pattern SWE, and the combination of SWE with ACR TI-RADS, respectively, for the differentiation of benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm was evaluated and compared. Among 270 thyroid nodules in 237 patients, 72 (26.67%) thyroid nodules were benign and 198 (73.33%) thyroid nodules were malignant. The qualitative color pattern SWE showed better diagnostic performance than the quantitative SWE parameters. When combining the qualitative color pattern SWE with ACR TI-RADS scores, with the optimal cutoff value of the total points ≥8, the thyroid nodules were considered malignant. The sensitivity, specificity, accuracy, and AUC were 89.90%, 56.94%, 81.11%, and 0.820 (95% CI: 0.768-0.864), respectively. Compared with using qualitative color pattern SWE alone, the combination of qualitative color pattern SWE and ACR TI-RADS had better diagnostic performance, which was significantly different (p < 0.05). The combination of qualitative SWE color patterns and ACR TI-RADS had high sensitivity and accuracy, which might be a convenient and useful method to differentiate benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. It would be helpful for the management of thyroid nodules and improving prognosis.

Ultrasonographic Characteristics of Thyroid Nodules with Nondiagnostic and Atypia of Undetermined Significance in Fine-Needle Aspiration Cytology.

This study aimed to investigate ultrasound (US) features of thyroid nodules categorized as nondiagnostic (ND) and atypia of undetermined significance (AUS) according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and their potential implications for clinical management. A retrospective study was conducted on patients who underwent thyroid nodules FNAC between 2019 and 2023. Nodules falling into the ND and AUS categories were analyzed for US features, nodule size, composition, echogenicity, shape, margin, echogenic foci, the distribution of the American College of Radiology's Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories, and other parameters. The study included a total of 1,199 patients and 1,252 nodules (ND: 1110; AUS: 142). No significant differences in age, gender, nodule features, echogenicity, shape, margin, echogenic foci, TI-RADS scores, localization, number of nodules, or thyroid parenchymal disease presence were found between the ND and AUS categories (p > 0.05). Also, no statistically significant difference in nodule size (<10 mm vs. ≥10 mm) existed between the ND and AUS categories (p = 0.475). Both showed predominantly solid composition and hyperechoic/isoechoic echogenicity. High proportions of TI-RADS 4 nodules were observed in both groups, with 727 (65.5%) in ND and 95 (66.9%) in AUS. This study found no statistically significant differences in US characteristics between the ND and AUS categories, indicating potential similarities in their radiological appearances. Also, no significant difference in nodule size (<10 mm and ≥10 mm) was observed between these categories. Clinical management should consider further investigations, including repeat FNAC, due to the diagnostic challenges and malignancy risk in both categories.

Ultrasound radiomics based XGBoost model to differential diagnosis thyroid nodules and unnecessary biopsy rate: Individual application of SHapley additive exPlanations.

Radiomics-based eXtreme gradient boosting (XGBoost) model was developed to differentiate benign thyroid nodules from malignant thyroid nodules and to prevent unnecessary thyroid biopsies, including positive and negative effects. The study evaluated a data set of ultrasound images of thyroid nodules in patients retrospectively, who initially received ultrasound-guided fine-needle aspiration biopsy (FNAB) for diagnostic purposes. According to ACR TI-RADS, a total of five ultrasound feature categories and the maximum size of the nodule were determined by four radiologists. A radiomics score was developed by the LASSO algorithm from the ultrasound-based radiomics features. An interpretative method based on Shapley additive explanation (SHAP) was developed. XGBoost was compared with ACR TI-RADS for its diagnostic performance and FNAB rate and was compared with six other machine learning models to evaluate the model performance. Finally, 191 thyroid nodules were examined from 177 patients. The radiomics score were calculated using 8 features, which were selected among 789 candidate features generated from the ultrasound images. The model yielded an AUC of 93% in the training cohort and 92% in the test cohort. It outperformed traditional machine learning models in assessing the nature of thyroid nodules. Compared with ACR TI-RADS, the FNAB rate decreased from 34% to 30% in training and from 35% to 41% in test. The radiomics-based XGBoost model proposed could distinguish benign and malignant thyroid nodules, thereby reduced significantly the number of unnecessary FNAB. It was effective in making preoperative decisions and managing selected patients using the SHAP visual interpretation tools.

Unnecessary fine needle aspiration cytological biopsy of thyroid nodules according to two ultrasound classification systems

Objective. To identify cytological FNA of thyroid nodules that would be unnecessary to perform according to US classification systems applied in our environment (ATA and ACR TI-RADS). Material and Methods. n=346 thyroid nodules were US and cytological evaluated in 293 patients (238 women and 55 men). Mean age without statistical significance between sexes (48.4/47.6 years old for males/women). Results. When the nodule characteristics are suspicious, both systems were similar in suggesting an FNA. But to discern which nodules not require FNA, ACR TI-RADS was significantly better than ATA classification, in terms of lower amount of Positive False and Specificity (P&lt;0.05). Complications: 5/293 (1.7%) superficial hematomas (early complications); no late complications were observed. Why were there FNA in nodules that had FNA even when both classifications suggested not to do so? doctor´s request (43.4%) and/or patient preference (32.4%), nodules in a context of a chronic thyroiditis parenchyma (12.4%) and purely cystic nodules &gt;35 mm, to evacuate the liquid content (11.8%). Conclusion. Nodules cytologically identified as suspicious was low. 94% of the FNA performed only required clinical follow-up. ACR TI-RADS classification induces fewer unnecessary FNA than ATA classification. Both classifications are wrong in equal proportion in suggesting no FNA suspicious nodules.

Benign thyroid nodules classified as ACR TI-RADS 4 or 5: Imaging and histological features

BackgroundAmerican College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) being most widely applied in clinical practice, there is an overlap in US imaging manifestations between benign and malignant thyroid nodules. ObjectivesTo analyze the imaging and histological characteristics of pathological benign thyroid nodules categorized as American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) 4 or 5, and to explore the correlation between the suspicious sonographic signs resulting in the misdiagnoses and the histopathological features. Materials and methodsOverall, 227 benign thyroid nodules (215 patients) in ACR TI-RADS 4 or 5 sampled through surgical excision were analyzed between December 2020 and August 2022. We retrospectively reread the ultrasound (US) images of the pathological discordant cases, after which we performed a systematic analysis focusing on the histopathological characteristics of thyroid lesions and recorded the findings. Qualitative US features and pathological significance of the thyroid nodules were analyzed using the chi-square and Fisher’s exact tests. ResultsThe pathological type of 227 thyroid nodules (n = 103 in ACR TI-RADS 4 and n = 124 in ACR TI-RADS 5) was nodular goiter together with other histopathological features, namely, fibrosis (n = 103, 45.4 %), calcification (n = 70, 30.8 %), adenomatous hyperplasia (n = 31, 13.7 %), follicular epithelial hyperplasia (n = 23, 10.1 %), Hashimoto’s thyroiditis (n = 18, 7.9 %), and cystic degeneration (n = 16, 7.1 %). Fibrosis was the most common histopathological feature in both ACR TI-RADS 4 (n = 42, 40.8 %) and 5 (n = 61, 49.2 %) categories of benign thyroid nodules. Thyroid nodules with fibrosis demonstrated sonographic features of “taller than wide” (p < 0.05), while lesions with follicular epithelial hyperplasia were likely to be detected with irregular and/or lobulated margins and very hypoechoic on US (p < 0.05 for both). ConclusionBenign thyroid nodules with histopathological findings such as fibrosis are associated with suspicious US features, which may give inappropriately higher TIRADS stratification.

Diagnostic value of American College of Radiology Thyroid Imaging Reporting and Data System combined with elastography in differentiating clinically atypical subacute thyroiditis from papillary thyroid carcinoma: a single retrospective research

BackgroundCommon ultrasound imaging is hard to distinguish thyroid nodules of clinically atypical subacute thyroiditis (CAST) with papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the diagnostic value of real-time elastography combined with American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) in differentiating these two lesions.ResultsCentripetal reduction echogenicity was only observed in the CAST nodules, with high specificity (100%) though low sensitivity (23.96%). Echogenic foci yielded good capability for differentiating PTC and CAST, with odds ratio (OR) of 36.572 and AUC of 0.788. Size and ES were independent factors to distinguish the two lesions with OR of 10.709 and 3.697, respectively. The combination of microcalcification, size < 10 mm and ES of 4 showed better AUC (0.885) than echogenic foci alone (p < 0.001). TI-RADS showed high sensitivity (91.23%) with specificity of 30.21% and AUC of 0.607 in predicting malignancy risk of PTC from CAST, while the AUC of ES and the combination of both methods were 0.508 and 0.585, respectively.ConclusionsCentripetal reduction echogenicity, echogenic foci, size and ES may assist in the differential diagnosis of CAST and PTC nodules. ACR TI-RADS is superior to ES and the combination of both methods for distinguishing these two lesions.

Automatic Detection of Thyroid Nodule Characteristics From 2D Ultrasound Images.

Thyroid cancer is one of the common types of cancer worldwide, and Ultrasound (US) imaging is a modality normally used for thyroid cancer diagnostics. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) has been widely adopted to identify and classify US image characteristics for thyroid nodules. This paper presents novel methods for detecting the characteristic descriptors derived from TIRADS. Our methods return descriptions of the nodule margin irregularity, margin smoothness, calcification as well as shape and echogenicity using conventional computer vision and deep learning techniques. We evaluate our methods using datasets of 471 US images of thyroid nodules acquired from US machines of different makes and labeled by multiple radiologists. The proposed methods achieved overall accuracies of 88.00%, 93.18%, and 89.13% in classifying nodule calcification, margin irregularity, and margin smoothness respectively. Further tests with limited data also show a promising overall accuracy of 90.60% for echogenicity and 100.00% for nodule shape. This study provides an automated annotation of thyroid nodule characteristics from 2D ultrasound images. The experimental results showed promising performance of our methods for thyroid nodule analysis. The automatic detection of correct characteristics not only offers supporting evidence for diagnosis, but also generates patient reports rapidly, thereby decreasing the workload of radiologists and enhancing productivity.

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

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 &gt;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.

Diagnostic performance of a new two-dimensional shear wave elastography expression using siemens ultrasound system combined with ACR TI-RADS for classification of benign and malignant thyroid nodules: A prospective multi-center study

ObjectiveThe present study aimed to evaluate the efficacy of a new two-dimensional shear wave elastography (2D-SWE) method using a Siemens ultrasound system and its combination with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for the differential diagnosis of benign and malignant thyroid nodules. MethodsConventional ultrasound images and 2D-SWE (E-whole-mean and E-stiffest-mean) were prospectively analyzed in 593 thyroid nodules from 543 patients. Nodules were divided into diameter (D) ≤10 mm and D > 10 mm groups and graded using ACR TI-RADS. The receiver operating characteristic curve was plotted using pathological findings as the gold standard. Diagnostic performance was compared among 2D-SWE, ACR TI-RADS, and their combination. ResultsThe area under the curve (AUC) for E-whole-mean was higher than that for E-stiffest-mean (0.858 vs. 0.790, P < 0.001), which indicated that it was the better 2D-SWE parameter for differentiating malignant nodules from benign nodules with an optimal cut-off point of 11.36 kPa. In the all-sizes group, the AUC for E-whole-mean was higher than that for ACR TI-RADS (0.858 vs. 0.808, P < 0.001). The combination of E-whole-mean and ACR TI-RADS resulted in a higher AUC (0.929 vs. 0.858 vs. 0.808, P < 0.001), sensitivity (87.0% vs. 80.3% vs. 85.2%), specificity (85.1% vs. 74.0% vs. 73.6%), accuracy (86.3% vs. 78.1% vs. 81.1%), positive predictive value (91.5% vs. 85.1% vs. 85.6%), and negative predictive value (78.0% vs. 67.0% vs. 72.9%) compared to E-whole-mean or ACR TI-RADS alone. The AUC for the combination of 2D-SWE and ACR TI-RADS was superior to that for E-whole-mean or ACR TI-RADS alone in both D ≤ 10 mm and D > 10 mm groups (P < 0.001). ConclusionAs the better 2D-SWE parameter, E-whole-mean had a higher diagnostic power than ACR TI-RADS and enhanced the diagnostic performance of ACR TI-RADS when identifying benign and malignant thyroid nodules. The combination of E-whole-mean and ACR TI-RADS improved the diagnostic performance compared to using ACR TI-RADS alone, providing a new and reliable method for the clinical diagnosis of thyroid nodules.

Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature.

While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults.

Correlation of ultrasound-based TIRADS and the Bethesda system for reporting of thyroid cytopathology: A study in a tertiary care centre.

The age-standardised incidence rate of thyroid cancer in India is 1 in 416 in the general population. This increased incidence has mainly been attributed to improved detection methods for small thyroid lesions. Two such methods are the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). To study the correlation between ACR TIRADS and TBSRTC, and between each system and the final histopathological report. Thyroid cytopathology cases were retrieved for the period January 2019 to July 2022. For each case, the TIRADS score and Bethesda category were noted. Histopathology specimens were also traced. The study comprised 1100 cases, with 955 female and 145 male patients (M:F = 1:6.59), and ages ranging between 7 and 85 years. The TIRADS scoring was available for 1036 cases. Histopathology was available for 231 cases. There was a significant correlation between TIRADS and TBSRTC, with a p-value of 0.000 and a substantial Kappa agreement of 0.688. Both TIRADS and TBSRTC also had significant correlations with the histopathology data, with a p-value of 0.000 for each. The sensitivity values for TBSRTC and TIRADS were 69.4% and 65.8%; specificity, 99.3% and 96.5%; positive predictive value (PPV), 98.3% and 91.8%; and negative predictive value (NPV) 84.7% and 84.4%, respectively. The risk of malignancy (ROM) was also calculated and was found to be high, especially for TBSRTC II, III, IV and V (11.3%, 20%, 61.5%, 97.4% respectively) and TIRADS 2 and 3 (10.3% and 29.6% respectively). The TIRADS and TBSRTC systems of categorisation of thyroid lesions are concordant and could help improve the overall survival rate of patients with thyroid malignancies.

Elastography of the thyroid nodule, cut-off points between benign and malignant lesions for strain, 2D shear wave real time and point shear wave: a correlation with pathology, ACR TIRADS and Alpha Score.

A prospective cross-sectional investigation of 170 thyroid nodules (TN) between January 2020 and December 2021 at Alpha Imagen was conducted to determine cut-off points (C/O) for elastography measurements and their diagnostic accuracy. Nodules were categorized by ACR TI-RADS, Alpha Score (AS), and Bethesda; all were evaluated using 2D Shear Wave Real Time Elastography (RT-SWE), point Shear Wave (pSWE), and Strain Elastography (SE). Data was assessed with ROC curves, the Shapiro-Wilk test, T test, Chi-square test, and ANOVA. C/O were as follows: RTSWE Emax of 115kPa and 6.5 m/s, Emean of 47.5 kPa and 4.1 m/s, pSWE (average) of 52.4 kpa and 4.15 m/s; sensitivity of 81.2% and specificity of 57.6%, with a PPV of 72.4% and NPV of 70.0%. SE Value A had a C/O of 0.20%, with a sensitivity of 84%, specificity of 57%, PPV of 72.4% and NPP of 73.6%. The Strain Ratio nodule/tissue C/O was calculated as 2.69, with a sensitivity of 84%, specificity of 57%, PPV of 72.3%, and NPV of 73.5%. The RLBIndex quality control must be at least 92%; for pSWE, we suggest a mean interquartile ratio of ≤15.7% for kPa and 8.1% for m/s. The recommended depth is between 1.2 and 1.5 cm, and commonly used ROI boxes were 3x3 and 5x5mm. 2D-SWE and pSWE with Emax and Emean demonstrated C/O with excellent diagnostic accuracy. To maximize the correct classification of TN, we suggest combining ACR TI-RADS and AS with any of the elastography measurements assessed here.

Abstract #1412895: Comparison of Radiological Features of ATA and TIRAD System of Evaluating Thyroid Nodules - A Prospective Study in a Tertiary Care Hospital of Pakistan

The occurrence of thyroid carcinoma had ascended through recent years. Excessive detection of thyroid nodules due to intensified use of thyroid ultrasonography and also increased FNAB (fine- needle aspiration biopsy) procedures are believed to cause the surge in the diagnosis of incidental papillary thyroid carcinomas. There have been two guidelines most commonly used in both clinical practice and scientific area; American Thyroid Association (ATA-2015) guideline and ACR-TIRADS (American College of Radiology - Thyroid Imaging Reporting and Data System) guideline. These guidelines have been established based on sonographic topographies and aim to distinguish nodules according to their doubt of malignancy to give recommendations for FNAB or follow-up. This study aims to compare the radiological features of ATA and TIRADS system of evaluating thyroid nodules. This was a prospective study, enrolling 105 patients. The patients presenting to Radiology Department of the study hospital with neck swelling/nodules for Ultrasound Neck and Thyroid were requested to participate in study after providing the informed consent. The participants must be of 18 years of age or above, however the patients with a known diagnosis of thyroid cancer or having recurrence of prior thyroid cancer were excluded. Proforma was filled as per ATA & ACR TI-RADS classification system. A few patients were followed with FNAB and Histopathology reports. Of all the nodules, 30 (28.5%) were benign, whereas 75 (71.5%) were malignant. ATA guidelines showed improved diagnostic efficiency than ACR TI-RADS (P<0.01). ACR TI-RADS confirmed a higher specificity (P<0.05), whereas the ATA outline had a higher sensitivity (P<0.01). The ACR-TIRADS and ATA guidelines performed better in differentiating nodules >1 cm. Both systems revealed good diagnostic presentation, however, ATA guidelines resulted in a superior number of thyroid biopsies or FNABs. Therefore, we believed that ACR-TIRADS is a better system in this regard, it can help us ruling out unnecessary biopsies.

The Prevalence and Associated Predictors for Diabetes Mellitus in Adult Patients With Thyroid Nodules.

Diabetes mellitus (DM) and thyroid nodules (TNs) with the risk of malignancy are increasing globally. Hence, we conducted this study to evaluate the prevalence and the associated predictors for DM among adult patients with TNs in Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). A retrospective study was conducted between January 1, 2015 and December 31, 2021. Patients with documented TNs based on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) were recruited. Then the prevalence and associated risk factors for DM were assessed. Three hundred ninety-one patients who had TNs were recruited. The median (interquartile range (IQR)) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. There was a high prevalence of DM (24.0%) among adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age, gender, 25-hydroxyvitamin D (25(OH)D) level, hypertension, bronchial asthma, free triiodothyronine (FT3), white blood cell count, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. In the multivariate analysis, there were significant associations between diagnosed DM among adult patients with TNs and age (odds ratio (OR) 1.037 (95% confidence interval (CI) 1.012 - 1.062)), hypertension (OR 0.374 (95% CI 0.203 - 0.689)), FT3 level (OR 0.635 (95% CI 0.412 - 0.980)), LDL (OR 0.643 (95% CI 0.456 - 0.907)) and HDL (OR 0.654 (95% CI 0.465 - 0.919)). There was a high prevalence of DM among patients with TNs. Age, hypertension, FT3, LDL and HDL were significantly associated with DM and TNs.