Does a higher American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI‐RADS) score forecast an increased risk of malignancy? A correlation study of ACR TI‐RADS with FNA cytology in the evaluation of thyroid nodules

Modi, Lopa; Sun, Wei; Shafizadeh, Negin; Negron, Raquel; Yee‐Chang, Melissa; Zhou, Fang; Simsir, Aylin; Sheth, Sheila; Brandler, Tamar C.

doi:10.1002/cncy.22254

Cited by 37 publications

(59 citation statements)

References 23 publications

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“…A good correspondence between radiology and cytology was noted in cases with ACR class 1–2, 90% (62/69) of which belonged to the <TIR3A (Bethesda AUS) group, and only seven nodules were classified as TIR3A, benefitting from a strict follow-up policy ( Table 2 ). These results support an excellent “rule-out” role for the ACR-TIRADS system that would significantly reduce the number of FNAs performed on benign nodules, as previously demonstrated [ 13 , 14 , 15 , 16 , 18 , 21 , 22 , 23 , 24 ]. For these cases, FNAs may be avoided if not strictly indicated by clinical needs, such as symptomatic goiter or therapeutic decompression of upper airways.…”

Section: Discussionsupporting

confidence: 85%

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

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Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.

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Section: Discussionsupporting

confidence: 85%

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Leni¹,

Seminati²,

Fior³

et al. 2021

Cancers

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“…According to Modi et al 2020, the mean nodule size in TIRADS 3 category was 2.9±1.27 cm. 11 The mean nodule size in TIRADS 4 category of our study was 1.9±1.05 cm. According to Modi et al 2020, the mean nodule size for the same category was 2.3±1.29.…”

Section: Discussionmentioning

confidence: 51%

“…According to Modi et al 2020, the mean nodule size for the same category was 2.3±1.29. 11 In TIRADS 5 category of our study the mean nodule size was 0.8 cm. According to Modi et al 2020, the mean nodule size in TIRADS 5 category was 1.7±1.11cm.…”

Section: Discussionmentioning

confidence: 52%

Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

2021

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Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.

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“…All radiologists retrospectively analyzed B-mode ultrasound images and evaluated the following features: composition, echogenicity, shape, margin and echogenic foci based on ACR TI-RADS categories [9]. A recent study showed there were no malignant diagnoses of thyroid in TR2 and TR3 (Bethesda, Category VI) [32]. TR3 is of low malignancy, therefore the cutoff between benign and malignant thyroid nodules was set at TR4 in this study.…”

Section: Analysis By Radiologistsmentioning

confidence: 99%

The value of S-Detect in improving the diagnostic performance of radiologists for the differential diagnosis of thyroid nodules

et al. 2020

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Aims: To compare the diagnostic value of S-Detect (a computer aided diagnosis system using deep learning) in differentiating thyroid nodules in radiologists with different experience and to assess if S-Detect can improve the diagnostic performance of radiologists.Materials and methods: Between February 2018 and October 2019, 204 thyroid nodules in 181 patients were included. An experienced radiologist performed ultrasound for thyroid nodules and obtained the result of S-Detect. Four radiologists with different experience on thyroid ultrasound (Radiologist 1, 2, 3, 4 with 1, 4, 9, 20 years, respectively) analyzed the conventional ultrasound images of each thyroid nodule and made a diagnosis of “benign” or “malignant” based on the TI-RADS category. After referring to S-Detect results, they re-evaluated the diagnoses. The diagnostic performance of radiologists was analyzed before and after referring to the results of S-Detect.Results: The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of S-Detect were 77.0, 91.3, 65.2, 68.3 and 90.1%, respectively. In comparison with the less experienced radiologists (radiologist 1 and 2), S-Detect had a higher area under receiver operating characteristic curve (AUC), accuracy and specificity (p <0.05). In comparison with the most experienced radiologist, the diagnostic accuracy and AUC were lower (p<0.05). In the less experienced radiologists, the diagnostic accuracy, specificity and AUC were significantly improved when combined with S-Detect (p<0.05), but not for experienced radiologists (radiologist 3 and 4) (p>0.05).Conclusions: S-Detect may become an additional diagnostic method for the diagnosis of thyroid nodules and improve the diagnostic performance of less experienced radiologists.

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Does a higher American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI‐RADS) score forecast an increased risk of malignancy? A correlation study of ACR TI‐RADS with FNA cytology in the evaluation of thyroid nodules

Cited by 37 publications

References 23 publications

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

The value of S-Detect in improving the diagnostic performance of radiologists for the differential diagnosis of thyroid nodules

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