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Examples of thyroid nodules submitted to cytological examination. (A) Nodule classified as TI-RADS 2; (B) TI-RADS 3; (C) TI-RADS 4A; (D) TI-RADS 4B; (E) TI-RADS 4C; (F) TI-RADS 5; cases A, B and C were considered benign; cases D, E and F were consider malignant according to Bethesda system (11)
Source publication
Objective
To correlate the Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda system in reporting cytopathology in 1,000 thyroid nodules.
Methods
A retrospective study conducted from November 2011 to February 2014 that evaluated 1,000 thyroid nodules of 906 patients who underwent ultrasound exam and fine needle aspiration.
Resul...
Context in source publication
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Background: Thyroid nodule is one of the most common endocrinopathies occurring children and adolescents. Though thyroid nodule is rare in the pediatric age group, the rate of malignancy is much higher in this age group compared to adult population.
Aim: The objective is to study the application of The Bethesda System for Reporting Thyroid Cytopath...
Introduction: Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) of Bethesda system for reporting thyroid cytopathology has emerged as most controversial category due to its heterogeneity and inconsistent usage. Initially associated risk of malignancy was estimated to be about 5–15%, but eventually di...
Thyroid fine-needle aspiration (FNA) biopsy has been widely accepted as an accurate and cost‑effective tool in the management of thyroid nodules. To avoid unnecessary FNAs and provide appropriate management, patient evaluation should be based on a multidisciplinary approach. For this purpose, the Thyroid Imaging Reporting and Data System (TI‑RADS)...
Background
Fine-needle aspiration cytology (FNAC) of thyroid is the initial screening test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has a recommended clinical management. The aim of this study is to analyze the thyroid cytology smears by Bethesda system an...
![Fig. 1. TIRADS classification algorithm [9].](publication/308816531/figure/fig1/AS:413558836875264@1475611518465/TIRADS-classification-algorithm-9_Q320.jpg)
Purpose: To compare between TIRADS and thyroid ultrasound classification system proposed by Kim and his colleagues.
Methods and materials: Prospective analysis of ultrasound and power Duplex images of 450 patients with thyroid gland disease was conducted. The thyroid lesions were categorized into 5 groups: TIRADS 1, Normal thyroid gland; TIRADS 2,...
Citations
... Among those classified as TI-RADS 4A, the proportion of malignancies was 16.0%, 43.2% in 4B, 72.7% in 4C, and 91.3% among TI-RADS 5 (p<0.001), demonstrating a clear association between TI-RADS and biopsy results (14). ...
... 9 Our study shows significant correlation of higher TIRADS score with histopathological findings. Similar results were seen studies of Junior et al., 18 and Srinivas et al. 19 In our study, female patients constituted about 74% of the total patients which is consistent with high incidence of thyroid nodules in females. Most of the patients were in the age bracket of 30-40 years. ...
... With the use of TIRADS scoring system, the number of avoidable FNACs can be reduced. [17][18][19][20] Since thyroid malignancies are slowgrowing lesions, a long-term follow-up is often required. TIRADS also provides management guidelines for thyroid lesions which includes follow-up or FNAC. ...
Background: With the increasing availability of ultrasound (USG) and concern for malignancy, there has been significant increase in the detection of thyroid lesions. However, there is no uniformity in the reporting pattern among radiologists, and hence, such USG reports are mostly inconclusive to exclude thyroid malignancy. Therefore, most of the patients have to undergo fine needle aspiration cytology or fine needle non-aspiration cytology (FNNAC), which is avoidable. The sonographic assessment of thyroid nodule can provide alternative method to this invasive modality of diagnosis. Therefore, the need was felt for establishing uniformity in USG reporting of thyroid nodules and risk stratification for malignancy with aim of reducing unnecessary FNNAC. Thyroid imaging reporting and data system (TIRADS) classification brings uniformity in reporting and reduces ambiguity in management of the patients.
Aims and Objectives: The objective of the study was to perform comparative evaluation of TIRADS and cytopathological evaluation of thyroid nodules FNNAC in Indian scenario.
Materials and Methods: Multicentric prospective study was conducted in the department of radio diagnosis and department of surgery at defence service hospitals of Jaipur and Chandimandir during the study period of July 01, 2017–October 31, 2022.
Results: Out of the 208 nodules, 28 (13.5%) turned out to be malignant. The percentage of malignant thyroid nodules was higher in nodules with TIRADS scores 4 and 5. The percentage of malignant thyroid nodules was 1% and 2%, respectively, for TIRADS 2 and 3 categories. The most common finding of USG evaluation was diffuse thyroiditis. There was a significant correlation between the USG findings and FNNAC findings in TIRADS scoring system.
Conclusion: Our study shows high degree of correlation between TIRADS classification and cytopathological evaluation of thyroid nodules. Hence, TIRADS can be used an effective tool for avoiding unnecessary FNNAC procedures.
... A study showed that 3 ultrasound features of solid thyroid nodules, including microcalcifications, marked low echo, and aspect ratio >1, are valuable in the diagnosis of thyroid malignancy (7). Another study indicated that the proportion of malignancies was 16.0% in 4A, 43.2% in 4B and 72.7% in 4C (8). In fact, quite a few TI-RADS 4 thyroid nodules are benign, and FNAB is unnecessary for them. ...
Objectives
To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary.
Methods
We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model.
Results
Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%.
Conclusion
In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.
... 15 One more recent study has established good concordance in all categories of the TIRADS with histopathology with slightly higher ROM in TR2. 36 In the present study, the TIRADS system was most concordant with the Bethesda system in benign (TR2 and BII) and malignant (TR5 and BV/VI) category. In this group, they were also most concordant with the final histopathology with 100% agreement. ...
... The predictive power of the ACR-TR system relative to the Bethesda cytopathology classification (7) has not been well established, as shown by heterogeneous findings reported in recent literature. (8)(9)(10) However, suspicious imaging findings are thought to be correlated with cytologic criteria of malignancy to a certain degree. ...
... That study compared the K-TR ultrasound classification with cytologic findings (Bethesda reporting system) of one thousand nodules submitted to retrospective and consecutive analysis between 2011 and 2014. (8) Given the methodology adopted in this study (consecutive sampling), the criteria for FNA indication were defined by assistant physicians in each case, and therefore do not reflect the original 2016 publication or any preestablished experimental criteria. Nodules included in the aforementioned publication were reclassified according to the ACR-TR system. ...
... However, most nodules (80.2%) fell in the Bethesda 2 category. These findings are consistent with the existing literature reporting that 79.3% to 85.4% of TR 3 or 4 nodules are Bethesda 2, (8)(9)(10) and substantiate the general notion that ACR-TR is correlated with risk of malignancy in FNA. (9,18) The ACR-TR system is thought to have high sensitivity and low specificity and can therefore be used as a screening tool. ...
Objective:
To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification.
Methods:
Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed.
Results:
Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories.
Conclusion:
Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.
... They include the American Thyroid Association (ATA) risk stratification system [10], Korean Society of Thyroid Radiology Thyroid Imaging Reporting and Data System (K-TIRADS) [11], American Association of Clinical Endocrinologists (AACE) [12], European Thyroid Association TIRADS (EU-TIRADS) [13], and the American College of Radiology (ACR) TI-RADS [14]. Recent studies have shown the ACR TI-RADS classification to be a reliable, non-invasive, and practical method for assessing thyroid nodules in routine practice, as well as outperforming the other classification in systems by allowing for the largest reduction of unnecessary thyroid nodule FNAs with the lowest negative predictive value at 2.2% [15][16][17][18][19][20]. ...
... Multiple thyroid nodule classification systems were developed to minimize the number of unnecessary FNAs while maintaining reasonable to high negative predictive values. ACR TI-RADS has been validated and shown to outperform the other classification systems in minimizing unnecessary FNAs with negative predictive values as low as 2.2% [15][16][17][18][19][20]. Starting from March 2019, Bluewater Health has transitioned from utilizing the LBP guidelines, which were largely based on the ATA classification system, to the ACR TI-RADS criteria for FNA recommendation. ...
... There were significantly more thyroid nodules with Bethesda III (malignant risk > 10%) in the ACR TI-RADS cohort versus the LBP cohort (21 versus 8, respectively, p = 0.005), as well as Bethesda IV or above (7 versus 0, respectively, p = 0.006). These findings are consistent with the literature demonstrating that ACR TI-RADS is reliable, specific, and outperforms the other classification systems in reducing unnecessary FNAs [15][16][17][18][19][20]. ...
Introduction
Thyroid 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
A total of 104 patients with 114 thyroid nodules underwent US-guided FNA at Bluewater Health from January 1, 2018, to March 31, 2020, with available cytological results (The Bethesda System). The study population was divided into two cohorts (January 1, 2018, to December 31, 2018 - ‘local best practice cohort’, and March 1, 2019, to March 31, 2020 - ‘ACR TI-RADS cohort’) based on the implementation of the ACR TI-RADS guidelines in March 2019.
Results
The local best practice cohort (January 1, 2018, to December 31, 2018) comprised 57 thyroid nodules in 52 patients (mean age 66 ± 12; 40 Women). The ACR TI-RADS cohort (March 1, 2019, to March 31, 2020) comprised 57 thyroid nodules in 52 patients (mean age 61 ± 16; 41 Women). There were no statistical differences with respect to age, gender, or thyroid nodule location. Our results show a dramatic decrease in the number of unnecessary FNAs if ACR TI-RADS was implemented from January to December 2018. Thirty (52.6%) of the previously sampled thyroid nodules using the local best practice guidelines would have been followed as per ACR TI-RADS.
Conclusion
ACR TI-RADS is a reliable classification system in routine practice that significantly reduces the number of unnecessary thyroid FNAs with higher specificity compared to local best practice guidelines.
... Comparable with the present findings, a study by Rahal et al. (2016) [20] showed that most nodules with a TIRADS score of 2 or 3 were mostly Bethesda grade 2 (95.5% and 92.5%, respectively). However, in this study, contrarily, the majority of the nodules with TIRADS 4 or 5 were also Bethesda 2 or 3. ...
... Comparable with the present findings, a study by Rahal et al. (2016) [20] showed that most nodules with a TIRADS score of 2 or 3 were mostly Bethesda grade 2 (95.5% and 92.5%, respectively). However, in this study, contrarily, the majority of the nodules with TIRADS 4 or 5 were also Bethesda 2 or 3. ...
Background
Thyroid nodules are a common presentation in otolaryngology-head and neck clinics. The detection of thyroid nodules has increased significantly with the advancements in radiological technology such as computed tomography and ultrasound (US). The present study aims to improve the clinical practice and management of thyroid disorders by establishing correlations between US and cytological findings in the diagnosis of thyroid nodules.
Methodology
A retrospective cohort study was conducted at the King Hamad University Hospital (KHUH), Bahrain. A total of 189 cases met the study criteria. Pathological records for thyroid nodule fine needle aspiration (FNA) cytology and US features of sampled nodules from the patients were obtained. The cytological results were categorized into the Bethesda grading system, while the US features were organized into internationally accepted features using the Thyroid Imaging Reporting and Data System (TIRADS).
Results
The radiologic characteristics from US showed positive features largely for the composition (76.2%) and vascularity (59.3%). Very few showed echogenicity (6.9%). Most records indicated negatively for the shape (94.7%), margins (76.2%), echogenicity (63.5%), or echogenic foci (66.1%). Of the 47 cases in TIRADS 1 and 2, only two were found to be Bethesda 4 classification, showing that most of these nodules were benign. Among those with TIRADS 3 on US, 85% turned were benign (Bethesda 2), two of the remaining six were grade 3, and the other four were suspiciously malignant. Of the 100 cases in TIRADS 4 and 5, 63% were of Bethesda grade 2, and therefore, benign, 14% were mildly suspicious, and only 23% were in Bethesda grades 4-6. A significant positive correlation was noted between the TIRADS and Bethesda scores (r = 0.338, p ≤ 0.001).
Conclusions
If the thyroid nodules are classified properly by US using the TIRADS system, the probability of a nodule being malignant can be established with a certain level of confidence. The appropriate management of the nodule can be initiated avoiding unwarranted FNA procedures.
... 1-3 This correlates with the reported prevalence at surgery and autopsy with ranges between 50% and 65%. 4,5 The use of highresolution ultrasound techniques has led to overdiagnosis and overtreatment of thyroid nodules. 3 Not all of them require surgical intervention. ...
... The purpose of TIRADS is to group the nodules into different categories with a designated percentage of malignancy. 5 Of the various TIRADS available, the American College of Radiology TIRADS (ACR-TIRADS) has emerged as standard method for reporting thyroid sonography findings. 6 Cytological evaluation of thyroid nodules is a rapid, easy, and inexpensive diagnostic procedure. ...
... Segundo observado por Tessler et al. (7) , o risco de malignidade para nódulos tireoideanos classificados segundo ACR TIRADS é o seguinte: categorias 1 e 2( ≤ 2%); categoria 3( ≤ 5%); categoria 4 (5,1-20%) e categoria 5 (>20%) (17,18). No presente trabalho a maioria dos nódulos categorizados ACR TIRADS 2 ou 3 apresentou citologia benigna, sendo compatível com o risco esperado (21) , porém, não se constatou associação estatística das categorias ACR TIRADS 4 ou 5 com maior risco de malignidade (Bethesda IV ou V), o que pode ser explicado parcialmente pela pequena quantidade de nódulos na amostra com citologia suspeita (n=4). ...
... Este estudo apresentou algumas limitações, sendo estas: a obtenção de dados por coleta retrospectiva; o uso de dados citológicos em vez de histopatológicos, apesar da alta sensibilidade e especificidade da citologia; a falta de uniformidade de critérios na indicação da PAAF, o que favoreceu a taxa elevada de citologias insatisfatórias (28,1%) (17,21,22) . Ressalta-se, porém, a importante adequabilidade de características utltrassonográficas benignas e minimamente suspeitas com resultado citológico benigno. ...
INTRODUÇÃO: Nódulos tireoideanos são bem comuns na população geral, sobretudo em mulheres, chegando a uma prevalência de até 68%. Em 2017, o Colégio Americano de Radiologia propôs um sistema de estratificação de risco (ACR TIRADS) para nortear a punção aspirativa por agulha fina (PAAF). A indicação de PAAF mais difundida baseia-se no ponto de corte de 1,0 cm para maior diâmetro do nódulo. OBJETIVOS: Avaliar a frequência dos achados ultrassonográficos, complicações, categorias ultrassonográficas e possíveis correlações com citologia de nódulos tireoideanos, submetidos a PAAF no Hospital Universitário da Universidade Federal do Piauí, no período de maio de 2017 a dezembro de 2018. METODOLOGIA: Estudo transversal, descritivo, com coleta retrospectiva dos dados. As variáveis estudadas foram: idade, sexo, tamanho do nódulo, características ultrassonográficas em modo bidimensional, vascularização ao Doppler colorido, ACR TIRADS e Bethesda. Para a análise foram obtidas médias, porcentagens e utilizados testes Qui-quadrado e Kappa. RESULTADOS: Dos 190 pacientes avaliados, 94,7% eram do sexo feminino, com média de idade de 55,9 anos. O diâmetro nodular médio foi de 2,19 cm, sendo a maioria destes sólidos e isoecogênicos, com resultado citológico Bethesda 2. A principal complicação foi o sangramento intranodular. CONCLUSÃO: A correta definição das características ecográficas de nódulos tireoieanos, pode nortear e racionalizar as indicações de PAAF.
... The TI-RADS scores ranged from 1 to 5, with 1 corresponding to no nodule, 2 and 3 to benign and probably benign with no suspicious US features, and then 4a, 4b, 4c, and 5 to 1, 2, 3, or 4 and 5 suspicious US features, respectively. In a retrospective study on 1000 patients [23], a significant association was found between the TI-RADS score and Bethesda classification (p < 0.001). Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and 92.5%, respectively). ...
Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains.
