Reducing the Number of Unnecessary Thyroid Nodule Biopsies With the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS)

Abstract

IntroductionThyroid nodules are exceedingly common, occurring in up to 76% of adults. Less than 10% are palpable, and the majority are detected incidentally with an estimated prevalence of 68%, 25%, and 18% using ultrasound (US), CT, and MRI, respectively. The rising use of imaging over the last four decades has led to a significant increase in nodule detection or 'over-identification,' fine-needle aspiration (FNA), a higher reported incidence of thyroid cancer, and thyroidectomy. The purpose of this study is to provide a descriptive experience with thyroid nodule FNAs one year prior and one year after the implementation of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) at a prototypical community hospital. Methods

Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

“…The current study demonstrated good concordance of ACR TI-RADS reporting system with Bethesda cytology among the 630 evaluable thyroid nodules. This finding was similar with previously reported series by Modi et al and Shaar et al among their series of 361 and 57 nodules, respectively. Collectively, ACR TI-RADS classification was useful in reducing number of unnecessary FNAC for benign nodules .…”

“…This finding was similar with previously reported series by Modi et al and Shaar et al among their series of 361 and 57 nodules, respectively. Collectively, ACR TI-RADS classification was useful in reducing number of unnecessary FNAC for benign nodules . When the ACR TI-RADS reporting system was correlated with eventual histopathology results, a stronger concordance of cancer than Bethesda cytology classification was found.…”

“…Collectively, ACR TI-RADS classification was useful in reducing number of unnecessary FNAC for benign nodules. 12,13 When the ACR TI-RADS reporting system was correlated with eventual histopathology results, a stronger concordance of cancer than Bethesda cytology classification was found. To our knowledge, comparing ACR TI-RADS with histopathology validation has not been previously reported.…”

Ultrasound Elastography: Basic Principles and Examples of Clinical Applications with Artificial Intelligence—A Review

“…Although FNAB is considered the gold standard for diagnosis, up to 15-30% of samples are considered nondiagnostic or indeterminate due to technical factors, such as insufficient sampling or histological dilemmas between similar histotypes [63]. In addition, the TI-RADS system is characterized by low diagnostic specificity, resulting in the execution of an excess number of invasive examinations [64].…”