ACR TI-RADS tops ATA guidelines for identifying malignant thyroid nodules

  • Ruan JL & al.
  • Eur Radiol
  • 4 Feb 2019

  • curated by Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • A retrospective study suggests that the American College of Radiology (ACR) thyroid image reporting and data system (TI-RADS) is superior to American Thyroid Association (ATA) guidelines for ultrasound (US) assessment of thyroid nodules and reliable recommendation of fine-needle aspiration biopsy (FNAB).

Why this matters

  • PTC is thought to be overdiagnosed, leading to a need for more accurate risk stratification.

Key results

  • 60.8% of thyroid nodules were benign and 39.2% were malignant.
  • ACR TI-RADS had 96.7% sensitivity, 77.3% specificity, 73.3% positive predictive value (PPV), 97.3% negative predictive value (NPV), and 84.9% accuracy.
  • ATA guidelines had 99.2% sensitivity, 16.1% specificity, 43.2% PPV, 97.0% NPV, and 48.7% accuracy.
  • ACR TI-RADS had a greater area under the curve compared with ATA guidelines (0.935 vs 0.884; P<.001>
  • Biopsy yield of malignancy, biopsy rates of malignancy, and unnecessary biopsy rates were 59.5%, 91.3%, and 40.5%, respectively, for ACR TI-RADS and 38.5%, 97.4%, and 61.5%, respectively, for the ATA guidelines.

Study design

  • 918 patients with 1001 thyroid nodules were analyzed by US, using the ACR TI-RADS and ATA systems.
  • Funding: Natural Science Foundation of Guangdong Province; National Natural Science Foundation of China.

Limitations

  • Retrospective study.
  • Only nodules that underwent FNAB were included, leading to potential selection bias.