The validity and reproducibility of the thyroid imaging reporting and data system (TI-RADS) in categorization of thyroid nodules: Multicentre prospective study

Basha, Mohammad Abd Alkhalik; Alnaggar, Ahmad Abdullah; Refaat, Rania; El-Maghraby, Ahmed Mohamed; Refaat, Mona; Elhamed, Marwa Elsayed Abd; Abdalla, Ahmed A El-Hamid M; Aly, Sameh Abdelaziz; Hanafy, Amr Shaaban; Mohamed, Abd El Motaleb; Afifi, Amira Hamed Mohamed; Harb, Ola A.

doi:10.1016/j.ejrad.2019.06.015

Cited by 43 publications

(45 citation statements)

References 32 publications

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“…A multicenter prospective study that included 380 patients with 948 thyroid nodules evaluated the reproducibility of the ACR-TIRADS classification among three experienced radiologists. The overall agreement for ACR-TIRADS categorization was 0.636 114. A prospective study evaluated two sets of around 500 thyroid nodule images reviewed by two clinicians with six years of experience and found that the inter-observer agreement increased after a joint review and discussion about discrepancies 115.…”

Section: Estimating the Risk Of Thyroid Cancer And Need For Thyroid Bmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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Section: Estimating the Risk Of Thyroid Cancer And Need For Thyroid Bmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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“…Various published risk-stratification guidelines [ 1 , 2 , 3 , 4 , 5 ] provide recommendations for the evaluation of thyroid nodules based on the combination of nodule size and ultrasonographic (US) appearance [ 6 ], with the aim of improving the standardization of thyroid ultrasound reporting and the identification of the small subset of nodules that warrant fine-needle aspiration biopsy (FNAB). The performance of these systems has been validated in retrospective [ 7 , 8 , 9 , 10 ] and prospective studies [ 11 , 12 , 13 ] and has also been confirmed by a recent meta-analysis [ 14 ]. Classification is usually based on the recognition of patterns of sonographic features, though the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) [ 4 ] assigns nodules points for each of five US categories, which are then added to determine a final class.…”

Section: Introductionmentioning

confidence: 85%

Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults

Grani

Brenta

Trimboli

et al. 2020

Cancers

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Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.

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“…The TI‐RADS published in 2017 by the American College of Radiology 8 has been applied recently in various capacities. 14‐25 However, none of the studies did a statistical analysis in correlation with TBSRTC which is virtually the standard practice in the field of cytopathology.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, TI‐RADS has shown better diagnostic value than any classical ultrasound criteria alone. 1‐7,14‐25 In a most recent multicenter ACR TI‐RADS validation study 25 reported by Basha et al, a total of 948 thyroid nodules were evaluated; 136 (14.3%) were malignant, and 812 (85.7%) were benign. The papillary carcinoma was the most common malignant thyroid nodules (81.6%).…”

Section: Discussionmentioning

confidence: 99%

A correlation study between thyroid imaging report and data systems and the Bethesda system for reporting thyroid cytology with surgical follow‐up‐ an ultrasound‐trained cytopathologist's experience

2020

Diagnostic Cytopathology

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Introduction Thyroid Imaging Reporting and Data Systems (TI‐RADS) including a modified system (M TI‐RADS) and American College Radiology (ACR) TI‐RADS are introduced. Correlation studies between both TI‐RADSs and The Bethesda System for Reporting Thyroid Cytology (TBSRTC) for Ultrasound‐guided fine‐needle aspiration (US‐FNA) cases with surgical follow‐up (SFU) are presented. Materials and Methods Three hundred and forty six thyroid US‐FNA cases performed at the US‐FNA clinic of Stony Brook University Hospital by an Ultrasound‐trained interventional Cytopathologist between December 1, 2014 to February 28, 2018 were reviewed. All ultrasound images from 346 cases were evaluated and assigned M TI‐RADS scores based on ultrasound features present in Table 1. One hundred and fifty four cases from Dcember 1, 2014 to February 28, 2016 were assigned scores using ACR TI‐RADS.TBSRTC category along with SFU data was collected and correlated with both TI‐RADS scores by using Pearson's correlation coefficient (r). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for M TI‐RADS and TBSRTC were also calculated using SFU diagnosis as a gold standard. McNemar test was applied to evaluate the significance of the difference between M TI‐RADS and TBSRTC. Results Based on 346 thyroid nodules studied, the overall r‐value between M TI‐RADS scores and TBSRTC categories is 0.465. The r‐values between Composition, Echogenicity, Shape, Margin, Echogenic foci, the summary points, and the converted TR level of ACR TI‐RADS and TBSRTC are 0.145, 0.042, 0.259, 0.310, 0.405, and 0.379, respectively. Fifty (14.5%) cases have SFUs. Considering TI‐RADS 5&6 and TBSRTC 5&6 as positives, and TI‐RADS 2 and TBSRTC 2 as negatives, the Sensitivity, Specificity, PPV, NPV, and accuracy are 96%, 53%, 76%, 89%, 79% for TI‐RADS vs 100%, 93%, 96%, 100%, 97% for TBSRTC, respectively (P = .038). The data for indeterminate cases are summarized. Conclusion Both TI‐RADSs could be helpful to a moderate degree. M TI‐RADS appeared to correlate to TBSRTC slightly better than that of ACR TI‐RADS. TBSRTC is significantly more accurate than M TI‐RADS for the majority of determined cases.

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The validity and reproducibility of the thyroid imaging reporting and data system (TI-RADS) in categorization of thyroid nodules: Multicentre prospective study

Cited by 43 publications

References 32 publications

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults

A correlation study between thyroid imaging report and data systems and the Bethesda system for reporting thyroid cytology with surgical follow‐up‐ an ultrasound‐trained cytopathologist's experience

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