Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules

Abstract

Background. Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. Objectives.To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. Materials and methods.The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. Results.Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%).Conclusions. Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Accuracy of Ultrasound Scans as Compared to Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules

“…A study conducted in Turkey in 2021 compared the reliability of the ATA and TI-RADS guidelines for thyroid US with FNAC results. It concluded that both guidelines can accurately predict malignancy, and may in fact eventually lead to a decrease in unnecessary FNAs [18].…”

“…A study conducted in Turkey in 2021 compared the reliability of the ATA and TI-RADS guidelines for thyroid US with FNAC results. It concluded that both guidelines can accurately predict malignancy, and may in fact eventually lead to a decrease in unnecessary FNAs [ 18 ]. Another study comparing the ATA, British Thyroid Association and TI-RADS showed that all three guidelines had sensitivities and NPV of over 90%, with ATA being the best at 98% and 95%, respectively [ 19 ].…”

T1 mapping and reduced field‐of‐view DWI at 3.0 T MRI for differentiation of thyroid papillary carcinoma from nodular goiter

“…On one hand, this study also showed that the combination of ADC and T1 values has the same diagnostic efficacy as TI‐RADS. The possible reason is that TI‐RADS would see the cystic and solid components, calcification and echo uniformity of thyroid nodules as the basis for judgement (Şahin et al, 2021). However, the dense cell arrangement and fibrous tissue hyperplasia of nodules could not be directly reflected on ultrasound images.…”

The application value of deep learning-based nomograms in benign–malignant discrimination of TI-RADS category 4 thyroid nodules

“…Thyroid ultrasonography was performed by our sonographers using ultrasound equipment from different manufacturers, including the GE LOGIQ E9 (probe model ML6-15), the HITACHI ARIETTA 70 (probe model EUP-C715), and the Mindray Resona R9T (probe model L14-5WU). The TI-RADS system 23 , proposed by the American Thyroid Association (ATA), was applied to assess the benign and malignant risk of thyroid nodules. Retrospective diagnosis of all ultrasound images was conducted by two chief physicians from the ultrasound department.…”