A practical trial to use Thyroid Imaging Reporting and Data System (TI-RADS) in differentiation between benign and malignant thyroid nodules

Abstract

Background: Thyroid nodules have been reported up to 68% in adults using ultrasound examination. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is founded on the evaluation of ultrasound (US) features in five categories: composition, echogenicity, shape, margin, and echogenic foci; the nodule’s total points determine its risk level, which ranges from TI-RADS1 (TR1) (benign) to TI-RADS5 (TR5) (highly suspicious). In conjunction with the nodule’s maximum diameter, the TR level determines whether to recommend a fine-needle aspiration (FNA) biopsy, a follow-up US examination, or no further action; our aim in this study was to apply ACR TI-RADS as a method for discrimination between benign and malignant nodules. Methods: We applied ACR TI-RADS template for 40 thyroid nodules, the total points given to thyroid nodules ranged from 0 to 14 points, then we compared our results with scintigraphy, fine-needle aspiration cytology (FNAC), and histopathological reports after surgery. Results: Of 40 thyroid nodules, 31 nodules (77.5%) were benign and 9 nodules (22.5%) were malignant; there was a statistically high significant trend of increasing risk of malignancy as the final TI-RADS level increased from TR1 to TR5 (P value < 0.001). Conclusion: The ACR TI-RADS scoring system is a simple easy method to be applied in daily ultrasound practice; it has an excellent diagnostic accuracy for the diagnosis of malignant thyroid nodules in the present study, as the aggregate risk of malignancy increased as the TI-RADS level increases from TR1 to TR5.