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Objective: To determine the risk of malignancy of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) indeterminate Thyroid Nodules (Bethesda III, IV and V) by combining cytologic (TSBRTC) and Thyroid Imaging Reporting and Data Systems (TI-RADS) ultrasonographic features based on final histopathology. Methods: Design: Retrospective review of records Setting: Tertiary Private Training Hospital Participants: 551 records Results: Among 81 eligible participants, 59 out of 84 nodules (70.24%) wer malignant on histopathology. The malignancy risk of Bethesda classification was 60.87% (28 out of 46) for Bethesda III, 57.14% (8 out of 14) for Bethesda IV and 95.83% for Bethesda V. The malignancy risk for TI-RADS categories was 0 % (0/1) for TI-RADS 2, 50% (10 out of 20) for TI-RADS 3, 71.05 % for TI-RADS 4 and 91.67 % for TI-RADS 5. The highest risk of malignancy (100%) was associated with [Bethesda IV/TI-RADS 1, 2, and 3], [Bethesda V/TI-RADS 1, 2 and 3 [Bethesda IV and V/TI-RADS 1, 2 and 3] and [Bethesda IV/TI-RADS 5]. The lowest risk of malignancy (33.33%) was associated with [Bethesda III/TI-RADS1, 2 and 3]. A high Bethesda classification (Bethesda V) was almost 5x more likely to have a malignant anatomorphology compared with Bethesda III (p = .05) while a TI-RADS 4 or 5 category was almost 5x more likely to have a malignant anatomorphology compared to TI-RADS 1, 2 or 3 (p = .026). Conclusion: This study showed that TI-RADS scoring is a sensitive diagnostic classification in recognizing patients with thyroid cancer and combining Bethesda classification and TI-RADS scoring increases the sensitivity in the diagnosis of malignant thyroid nodules. A higher likelihood of malignancy is associated with higher Bethesda classification and TI-RADS scoring.

Background: The performance in evaluating thyroid nodules on ultrasound varies across different risk stratification systems, leading to inconsistency and uncertainty regarding diagnostic sensitivity, specificity, and accuracy. Objective: Comparing diagnostic performance of detecting thyroid cancer among distinct ultrasound risk stratification systems proposed in the last five years. Evidence acquisition: Systematic search was conducted on PubMed, EMBASE, and Web of Science databases to find relevant research up to December 8, 2022, whose study contents contained elucidation of diagnostic performance of any one of the above ultrasound risk stratification systems (European Thyroid Imaging Reporting and Data System[Eu-TIRADS]; American College of Radiology TIRADS [ACR TIRADS]; Chinese version of TIRADS [C-TIRADS]; Computer-aided diagnosis system based on deep learning [S-Detect]). Based on golden diagnostic standard in histopathology and cytology, single metaanalysis was performed to obtain the optimal cut-off value for each system, and then network meta-analysis was conducted on the best risk stratification category in each system. Evidence synthesis: This network meta-analysis included 88 studies with a total of 59,304 nodules. The most accurate risk category thresholds were TR5 for Eu-TIRADS, TR5 for ACR TIRADS, TR4b and above for C-TIRADS, and possible malignancy for S-Detect. At the best thresholds, sensitivity of these systems ranged from 68% to 82% and specificity ranged from 71% to 81%. It identified the highest sensitivity for C-TIRADS TR4b and the highest specificity for ACR TIRADS TR5. However, sensitivity for ACR TIRADS TR5 was the lowest. The diagnostic odds ratio (DOR) and area under curve (AUC) were ranked first in C-TIRADS. Conclusion: Among four ultrasound risk stratification options, this systemic reviewpreliminarily proved that C-TIRADS possessed favorable diagnostic performance for thyroid nodules. [ABSTRACT FROM AUTHOR]

Objective: To determine if the artificial intelligence‐based Thyroid Imaging, Reporting and Data System (AI TIRADS) would perform better than the American College of Radiology (ACR) TIRADS in monitoring malignant thyroid nodules not recommended for biopsy using follow‐up thresholds. Methods: A total of 3499 thyroid nodules with surgical histopathology and ultrasound features were retrospectively reviewed and categorized using ACR TIRADS and AI TIRADS. The recommendations for biopsy and follow‐up divided nodules into three groups 1) fine needle aspiration (FNA), 2) follow‐up ultrasound, and 3) no further evaluation. Results: Of the total 1608 malignant nodules in this study, 974 malignant nodules would not be biopsied in ACR TIRADS compared with 967 in AI TIRADS. While 60.0% (584/974) of these non‐biopsied malignancies could be followed‐up by ultrasound in ACR TIRADS and 62.8% (607/967) in AI TIRADS. For the malignancies of no further evaluation, 97.4% (380/390) were sized <10 mm in ACR TIRADS and 93.3% (336/360) in AI TIRADS. Compared with ACR TIRADS, AI TIRADS had lower unnecessary FNA rate and missing cancer rate (41.0% vs 47.8% and 22.8% vs 27.5%, P <.05, respectively) while having higher specificity and AUC as well as lower sensitivity (65.0% vs 57.9%, 0.895 vs 0.881, and 96.1% vs 97.8%, all P <.05). Conclusions: Using the follow‐up thresholds, more than half of the malignancies not being biopsied were monitored by ultrasound in both ACR TIRADS and AI TIRADS, and AI TIRADS had lower missing cancer rate. More than 90% of malignancies recommended for no further evaluation were <10 mm in diameter. [ABSTRACT FROM AUTHOR]

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.

Objective To explore the efficiency of ACR TI-RADS score in the diagnosis of benign and malignant thyroid nodules by constructing the receiver operating characteristic(ROC) curve.Methods The data of the patients undergoing thyroid examination in the special diagnosis department of this hospital from November 2019 to December 2021 were collected.A total of 379 thyroid nodules from 286 patients were included as the research objects, and each nodule was scored according to the 2017 version of ACR TI-RADS guidelines.With the pathological results as the golden standard, the ROC curve was constructed and the area under the curve (AUC) was calculated to determine the best diagnostic cutoff value, and the accuracy, sensitivity, specificity, negative predictive value and positive predictive were calculated, respectively.Results Among 248 benign nodules, the score in 241 nodules ≤6 points, accounting for 97.1%(241/248).Among 131 malignant nodules, the score in 56 nodules were ≤6 points, accounting for 42.7%(56/131), and the difference between them was statistically significant (P <0.05);the score of benign nodules was higher than 6 points in 7 cases, accounting for 2.9% (7/248), the score of malignant nodules was higher than 6 points in 75 cases, accounting for 57.3%(75/131), and the difference between them was statistically significant(P <0.05).AUC obtained by constructing ROC curve was 0.912, the Jordan index was 0.654, and the best diagnostic cut-off value was 5.5 points.With ≥5.5 points as the cutoff value, the accuracy, sensitivity, specificity, negative predictive value and positive value were 77.1%, 88.3%, 84.4%, 87.9% and77.6% respectively.Conclusion The higher the ACR TI-RADS score, the higher the risk of malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Background Ultrasonographic evaluation of thyroid nodules is challenging due to their high frequency and low malignancy rate. The risk stratification system developed by the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) focuses on addressing the primary contemporary objectives for these lesions, aiming to decrease unnecessary biopsies while maintaining a similar specificity compared with other risk stratification systems. Generally, when indicative of malignancy by ultrasound findings, the next best step in management is an evaluation by fine needle aspiration biopsy (FNAB) and cytological analysis with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) results that determine further evaluation requirements, actions that are based on the risk of malignancy (ROM) of the assigned category, which could include surgical intervention. Objectives To validate and analyze the individual impact of each ultrasonographic finding indicative of malignancy in the ACR TI-RADS guidelines based on their respective correlation with results obtained by TBSRTC. Materials and method Reports for 212 thyroid ultrasound-guided FNABs from 2018 to 2020 were assessed. Only 117 had both ACR TI-RADS and TBSRTC reports available and were analyzed. Nodules were divided into two groups: ROM < 5% (Bethesda 1, 2; n = 58), and ROM > 5% (Bethesda 3, 4, 5, 6; n = 59). Statistical analysis was performed using the x 2 test and bivariate logistic regression model for each characteristic included in ACR TI-RADS. Results Individual ultrasound characteristics with a more pronounced distribution towards the Bethesda > 5% malignancy group were: solid or almost completely solid composition (n=53, 62.3%), very hypoechoic echogenicity (n=3, 75%), wider-than-tall shape (n=50, 50.5%), lobulated or irregular margin (n=23, 65.7%), punctate echogenic foci (n=18, 72%), and thyroid isthmus location (n=6, 75%). Statistically significant individual ultrasonographic characteristics indicative of malignancy included solid or almost completely solid (p = 0.005), very hypoechoic echogenicity (p = 0.046), margin lobulated or irregular (p = 0.031), and punctate echogenic foci (p = 0.015). No significant association was found in the taller-than-wide shape for differentiating malignant from benign lesions (p = 0.969). Conclusions Specific ultrasound characteristics identified in the ACR TI-RADS system demonstrate a stronger correlation with an increased risk of malignancy when compared with cytologic evaluation results. These characteristics include a solid composition, lobulated or irregular margins, punctate echogenic foci, and very hypoechoic echogenicity. Our findings revealed that the scale points for the taller-than-wide characteristic do not adequately represent its true influence on the risk of malignancy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Comité de Investigación Centro Médico ABC issued approval CMABC-24-05 dated January 8, 2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Castilla Villanueva et al.)

Background: Thyroid nodules are a frequent finding on neck sonography. The US is the most commonly used imaging technique for the evaluation of thyroid nodules. The Thyroid Imaging, Reporting and Data System (TIRADS) developed by the American college of radiology (ACR) for classification of thyroid nodules is a practical and convenient method for risk stratification of thyroid malignancy, based on allocating points for different sonographic features of thyroid nodules in five morphologic categories (composition, echogenicity, margins, shape, and presence of echogenic foci). Objective: To evaluate the role of macrocalcification in raising the suspicious of malignancy among ACR TIRADS 3 and 4 group without macrocalcification Patients and Methods: Our study was conducted on 60 adult patients, 20 patients with TIRADS 3 nodule, 20 patients with TIRADS 4 group with macrocalcification nodules and 20 patients group TIRADS 4 without macrocalcification nodules, whose ages range between 23 and 65 years old and were referred to undergo FNA procedures. Results: The present study concludes parenchymal macrocalcifications showed no statistically significant difference in raising percentage of malignancy among TIRADS 4 patients. Conclusion: We conclude that the added macrocalcification showed no statistically significant difference in raising percentage of malignancy compared to TIRADS 4 without calcification group. Also, presence of macrocalcification should not prevent clinicians from making further assessments in case of nondiagnostic results to exclude their association with rather than their causal relation with thyroid malignancies. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules are usually an incidental finding. Most of them are characterized by ultrasound. Purpose: To evaluate the interobserver variability for evaluation of thyroid nodule characteristics in the lexicon of ACR-TIRADS and the recommendation for biopsy. Material and methods: The study comprises 25 thyroid nodules evaluated by four certified radiologists and eight radiology residents with different academic degrees according to the five ACR-TIRADS categories. After an update session, the same patients were analyzed and a new decision was obtained. The variability was evaluated with the Fleiss kappa statistical test. Results: Interobserver correlation coefficient for stratification according to TIRADS obtained a kappa value of 0.955 (p <0.001). For BAAF decision a kappa value of 0.892 (p <0.001) was obtained. After the update session intraobserver correlation is strong for TIRADS. Conclusion: There is no interobserver variability for categorization according to TIRADS, regardless of academic grade. [ABSTRACT FROM AUTHOR]

Introduction Thyroid nodules are frequently encountered and may be discovered roughly in around 4-8% of individuals by clinical palpation. Aim The present study aims to analyze the Thyroid Imaging Reporting and Data Systems (TIRADS) classification and assess the validity of each criterion in predicting malignancy. Methods A prospective observational study was conducted at Sri Ramachandra Institute of Higher Education and Research from June 2020 to October 2021. Fifty patients who presented to the outpatient clinic with thyroid swelling got an ultrasound (USG) neck performed followed by either fine-needle aspiration cytology (FNAC) or thyroidectomy. They were included in the study and informed consent was obtained from all patients. Results Among 50 patients considered for the study, 36 were females. The mean age for malignant patients is 46 years with a standard deviation (SD) of 15, and for benign lesions is 47 years with an SD of 1. Most of the patients were TIRADS 4, which has a 56.2% risk of malignancy. The pathological results show a significant difference in ACR (American College of Radiology) TIRADS and echogenic foci between FNAC. The present study's solid composition showed a sensitivity of 25% and specificity of 75%, with an odds ratio of 0.90 in picking up malignant nodules. The shape of a nodule taller than wider, a malignant feature, showed a specificity of 92.3%. Punctate echogenic foci showed a sensitivity of 50% and specificity of 76.9% with a statistical significance of p-value 0.048. Conclusion TIRADS scoring avoids unessential invasive techniques for lower TIRADS scores. Certain criteria are more specific in recognizing malignant nodules. Proportional priority shall be given to certain criteria over others, and not all criteria should be considered., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kallepalli et al.)