Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

Abstract

Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

“…EU-TIRADS categories have been observed to be related to thyroid nodules malignancy, although the performance of such system should be improved and therefore a FNAB is currently recommended in all EU-TIRADS ≥4 nodules ( 50 , 72 – 75 ), as cancer underdiagnosis rate rises to 37.7% ( 55 , 72 – 80 ). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EU-TIRADS in adulthood are between 70.6-83.5%, 51.2-94.1%, 11.8-76.1% and 85.4-94.9%, respectively ( 62 , 73 – 75 , 77 , 78 ). The performance of EU-TIRADS in paediatric age has been evaluated in a few studies that showed lower efficacy than in adults, with sensitivity, specificity, PPV and NPV ranging between 41.7-100%, 25-75.9%, 41.7-44%, 75.9-100% respectively ( 63 , 78 , 79 ).…”

“…The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EU-TIRADS in adulthood are between 70.6-83.5%, 51.2-94.1%, 11.8-76.1% and 85.4-94.9%, respectively ( 62 , 73 – 75 , 77 , 78 ). The performance of EU-TIRADS in paediatric age has been evaluated in a few studies that showed lower efficacy than in adults, with sensitivity, specificity, PPV and NPV ranging between 41.7-100%, 25-75.9%, 41.7-44%, 75.9-100% respectively ( 63 , 78 , 79 ). The data from our study confirm the significant correlation of the EU-TIRADS category with malignancy.…”

The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study

“…The exploration of the nodules involves a clinical examination, completed by an ultrasound using the EU-TIRADS score, the hormonal dosage, the cytopuncture, using the Bethesda score and, of course, the biopsy after the surgery [ 5 , 6 , 7 , 8 , 9 , 10 ]. Thyroid ultrasound has become a key examination in the management of thyroid nodules [ 2 , 10 , 11 , 12 , 13 ]. In countries with sufficient iodine intake, clinical-based prevalence of thyroid nodules amounts to 5.3–6.4% in women and 0.8–1.6% in men.…”

Standardisierte Akquisition und Dokumentation von Videosequenzen bei der konventionellen Schilddrüsensonografie

“…den nationalen und internationalen Leitlinien als Basisdiagnostik für die Beurteilung von Schilddrüsenknoten benannt [3,4]. Die Einführung sonografischer Risikostratifizierungssysteme (TIRADS) spielt dabei eine zentrale Rolle [5]. Zudem besitzt die Methode einen hohen Stellenwert bei der Behandlung von Autoimmunerkrankungen und Thyreoiditiden, in der Verlaufskontrolle nach Schilddrüsentherapien und in der Nachsorge von Schilddrüsenkarzinomen [2,6,7].…”