Using the American College of Radiology Thyroid Imaging Reporting and Data System at the Point of Care: Sonographer Performance and Interobserver Variability

Wildman-Tobriner, Benjamin; Ahmed, Salmaan; Erkanli, Al; Mazurowski, Maciej A.; Hoang, Jenny K.

doi:10.1016/j.ultrasmedbio.2020.04.019

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…Compared to the other sonographic criteria, shape and margin are scored either 0 or 3, and 0, 2, or 3, respectively. Differences in opinion with respect to shape and margin can certainly have a big impact on the overall TI-RADS score and, ultimately, whether a patient will need FNA or not [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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

Shaar¹,

Meteb²,

El-Karim³

et al. 2022

Cureus

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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

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Section: Discussionmentioning

confidence: 99%

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

Shaar¹,

Meteb²,

El-Karim³

et al. 2022

Cureus

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“…Our findings also suggest the possibility of a future revision of the weights attributed to some ACR-TIRADS system features, with an eventual reduction in the scores associated with solid composition and hypoechogenicity (2 points each), whose impact on the screening process was not particularly relevant in this study ( Table 3 ). Moreover, future improvements in the algorithm might include alternative characteristics, such as elastography, that already demonstrated a potential impact in classification systems used for other organs and districts [ 29 , 30 , 31 , 32 ]. As per previous studies relying on the ACR-TIRADS class, FNA would be indicated in a range of 17% to 40%; in this paper, cases with FNA indicated by the ACR system accounted for 46.5% of the nodules, confirming its high “rule-out” role.…”

Section: Discussionmentioning

confidence: 99%

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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“…As our data indicate, it is worthwhile to perform proper measurements because even a minor modification of the threshold for nodule’s suspicious shape may lead to a several-fold change in SEN of that feature and marked changes in its SPC and RoM. The local experience of a center is especially valuable in this case, because the reproducibility of the assessment of nodule’s suspicious shape, like other US malignancy features, is not high [ 36 ]. It results not only from technical differences in measurements (e.g., caused by different positions of a patient, or different pressure exerted by a probe on the examined area), but also from differences in the epidemiology of thyroid diseases in examined patients (different incidence of HT, other profile of cancers).…”

Section: Discussionmentioning

confidence: 99%

Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto’s Thyroiditis; Impact of Changes in the Threshold for Nodule’s Shape Criterion

Słowińska-Klencka

Klencki

Wojtaszek-Nowicka

et al. 2021

Cancers

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The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included 1188 nodules (HT: 358, non-HT: 830) with known final diagnoses. We found that the strongest indications of nodule’s malignancy were microcalcifications (OR: 22.7) in HT group and irregular margins (OR:13.8) in non-HT group. Solid echostructure and macrocalcifications were ineffective in patients with HT. The highest accuracy of nodule’s shape criterion was noted on transverse section, with the cut-off value of anteroposterior to transverse dimension ratio (AP/T) close to 1.15 in both groups. When round nodules were regarded as suspicious in patients with HT (the cut-off value of AP/T set to ≥1), it led to a three-fold increase in sensitivity of this feature, with a disproportionally lower decrease in specificity and similar accuracy. Such a modification was effective also for cancers other than PTC. The diagnostic effectiveness of analyzed TIRADS in patients with HT and without HT was similar. Changes in the threshold for AP/T ratio influenced the number of nodules classified into the category of the highest risk, especially in the case of EU-TIRADS.

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Using the American College of Radiology Thyroid Imaging Reporting and Data System at the Point of Care: Sonographer Performance and Interobserver Variability

Cited by 11 publications

References 9 publications

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

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

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

Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto’s Thyroiditis; Impact of Changes in the Threshold for Nodule’s Shape Criterion

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