DIAGNOSTIC ACCURACY OF ULTRASOUND IN CHARACTERIZATION OF THYROID NODULES ON THE BASIS OF TIRADS CLASSIFICATION KEEPING FNAC AS GOLD STANDARD
DOI:
https://doi.org/10.71000/qw785274Keywords:
malignancy, , TIRADS, Cytology, Diagnosis, Sensitivity and Specificity, Thyroid Nodule, UltrasonographyAbstract
Background: Thyroid nodules are increasingly common and pose a diagnostic challenge, particularly in distinguishing benign from malignant lesions. In low-resource settings like Pakistan, effective and accessible diagnostic tools are essential to guide appropriate clinical management and avoid unnecessary invasive procedures. The Thyroid Imaging Reporting and Data System (TIRADS) offers a standardized ultrasonographic approach for risk stratification of thyroid nodules. However, its validation in local populations remains limited.
Objective: To assess the diagnostic performance of TIRADS in differentiating benign and malignant thyroid nodules in a Pakistani population, using fine-needle aspiration cytology (FNAC) as the reference standard.
Methods: A cross-sectional validation study was conducted at Jinnah Postgraduate Medical Centre, Karachi, from April to September 2024. A total of 100 patients with thyroid nodules were enrolled. Ultrasound examinations were performed by an experienced radiologist using a 7–15 MHz transducer. Nodules were categorized according to TIRADS, and all participants underwent FNAC for histological confirmation. Diagnostic metrics—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—were calculated. Stratified analysis was conducted based on gender, age, location, and thyroid function status.
Results: The mean age of participants was 46.91 ± 18.25 years, with a slight female predominance (56%). Malignancy was identified in 64% of cases on ultrasound and 78% on FNAC. TIRADS demonstrated 80.8% sensitivity, 95.5% specificity, 98.4% PPV, 58.3% NPV, and 84.0% overall accuracy. TIRADS 5 was the most frequent category (24%). Higher sensitivity was noted among rural residents (85.7%) and females (84.1%), while specificity declined in patients over 60 years (80%).
Conclusion: TIRADS offers high diagnostic accuracy in confirming thyroid malignancy and is a valuable triage tool in resource-limited settings. However, its limited NPV warrants cautious interpretation of low-risk classifications. Local validation and radiologist training are essential for optimized use.
Background: Thyroid nodules are increasingly common and pose a diagnostic challenge, particularly in distinguishing benign from malignant lesions. In low-resource settings like Pakistan, effective and accessible diagnostic tools are essential to guide appropriate clinical management and avoid unnecessary invasive procedures. The Thyroid Imaging Reporting and Data System (TIRADS) offers a standardized ultrasonographic approach for risk stratification of thyroid nodules. However, its validation in local populations remains limited.
Objective: To assess the diagnostic performance of TIRADS in differentiating benign and malignant thyroid nodules in a Pakistani population, using fine-needle aspiration cytology (FNAC) as the reference standard.
Methods: A cross-sectional validation study was conducted at Jinnah Postgraduate Medical Centre, Karachi, from April to September 2024. A total of 100 patients with thyroid nodules were enrolled. Ultrasound examinations were performed by an experienced radiologist using a 7–15 MHz transducer. Nodules were categorized according to TIRADS, and all participants underwent FNAC for histological confirmation. Diagnostic metrics—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—were calculated. Stratified analysis was conducted based on gender, age, location, and thyroid function status.
Results: The mean age of participants was 46.91 ± 18.25 years, with a slight female predominance (56%). Malignancy was identified in 64% of cases on ultrasound and 78% on FNAC. TIRADS demonstrated 80.8% sensitivity, 95.5% specificity, 98.4% PPV, 58.3% NPV, and 84.0% overall accuracy. TIRADS 5 was the most frequent category (24%). Higher sensitivity was noted among rural residents (85.7%) and females (84.1%), while specificity declined in patients over 60 years (80%).
Conclusion: TIRADS offers high diagnostic accuracy in confirming thyroid malignancy and is a valuable triage tool in resource-limited settings. However, its limited NPV warrants cautious interpretation of low-risk classifications. Local validation and radiologist training are essential for optimized use.
References
Youssef A, Abd-Elmonem MH, Ghazy RA, El Shafei MM, Zahran M. The diagnostic value of ultrasonography in detection of different types of thyroid nodules. Egypt J Otolaryngol. 2020; 36:1-7.
Wildman-Tobriner B, Yang J, Allen BC, Ho LM, Miller CM, Mazurowski MA. Simplifying risk stratification for thyroid nodules on ultrasound: validation and performance of an artificial intelligence thyroid imaging reporting and data system. Curr Probl Diagn Radiol. 2024;53(6):695-9.
Topcuoglu OM, Uzunoglu B, Orhan T, Basaran EB, Gormez A, Sarica O. A real-world comparison of the diagnostic performances of six different TI-RADS guidelines, including ACR-/Kwak-/K-/EU-/ATA-/C-TIRADS. Clin Imaging. 2025;117:110366.
Zhang YJ, Xue T, Liu C, Hao YH, Yan XH, Liu LP. Radiomics Combined with ACR TI-RADS for Thyroid Nodules: Diagnostic Performance, Unnecessary Biopsy Rate, and Nomogram Construction. Acad Radiol. 2024;31(12):4856-65.
Wu S, Shu L, Tian Z, Li J, Wu Y, Lou X, et al. Predictive Value of the Nomogram Model Based on Multimodal Ultrasound Features for Benign and Malignant Thyroid Nodules of C-TIRADS Category 4. Ultrason Imaging. 2024;46(6):320-31.
Ruan J, Xu X, Cai Y, Zeng H, Luo M, Zhang W, et al. A Practical CEUS Thyroid Reporting System for Thyroid Nodules. Radiology. 2022;305(1):149-59.
Lee DH, Cho YJ, Won JK, Lee SB, Choi YH, Jung KC, et al. Pediatric Thyroid Nodules: K-TIRADS/ACR TI-RADS Pediatric-Specific Biopsy Cutoff Incorporating Clinical Risk Factors. Radiology. 2025;315(3):e241015.
Zhang WB, Deng WF, He BL, Wei YY, Liu Y, Chen Z, et al. Diagnostic value of CEUS combined with C-TIRADS for indeterminate FNA cytological thyroid nodules. Clin Hemorheol Microcirc. 2024;88(4):475-83.
Aribon PA, Teope E, Egwolf AL, Maningat MP. Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study. J ASEAN Fed Endocr Soc. 2024;39(1):61-8.
Huh S, Yoon JH, Lee HS, Moon HJ, Park VY, Kwak JY. Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS' size thresholds for FNA. Eur Radiol. 2021;31(7):5243-50.
Watkins L, O'Neill G, Young D, McArthur C. Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate. Br J Radiol. 2021;94(1123):20201444.
Sun J, Wu B, Zhao T, Gao L, Xie K, Lin T, et al. Classification for thyroid nodule using ViT with contrastive learning in ultrasound images. Comput Biol Med. 2023;152:106444.
Ashton J, Morrison S, Erkanli A, Wildman-Tobriner B. Assessment of the Diagnostic Performance of a Commercially Available Artificial Intelligence Algorithm for Risk Stratification of Thyroid Nodules on Ultrasound. Thyroid. 2024;34(11):1379-88.
Samargandy S, Ghoneim AH. Accuracy of ultrasound in predicting thyroid malignancy: a comparative analysis of the ACR TI-RADS and ATA risk stratification systems. Arch Endocrinol Metab. 2024;68:e230245.
Kim DH, Chung SR, Choi SH, Kim KW. Accuracy of thyroid imaging reporting and data system category 4 or 5 for diagnosing malignancy: a systematic review and meta-analysis. Eur Radiol. 2020;30(10):5611-24.
Hasannia MA, Pourghorban R, Asefi H, Aria A, Nazar E, Ebrahiminik H, et al. Diagnostic yield of fine needle aspiration with simultaneous core needle biopsy for thyroid nodules. J Pathol Transl Med. 2025;59(3):180-187.
Al-Ghanimi IA, Al-Sharydah AM, Al-Mulhim S, Faisal S, Al-Abdulwahab A, Al-Aftan M, et al. Diagnostic Accuracy of Ultrasonography in Classifying Thyroid Nodules Compared with Fine-Needle Aspiration. Saudi J Med Med Sci. 2020;8(1):25-31.
Saqib HA, Saeed U, Zahra M, et al. Diagnostic accuracy of TIRADS classification in differentiating benign and malignant thyroid nodules keeping fine needle aspiration cytology (FNAC) as gold standard. Biol Clin Sci Res J. 2024; 2024:742.
Wajiha Sohail Khan, Syed Muhammad Yousaf Farooq, Sadia Nawaz. Accuracy of ultrasound TIRADS classification for the differentiation between benign and malignant thyroid lesions taking Bethesda classification as gold standard. Imaging. 2024;16(2):94-100.
Wahid G, Tamkeen N, Maqsood F, et al. Diagnostic accuracy of ultrasound in detecting malignant thyroid nodules keeping histopathology as gold standard. J Postgrad Med Inst. 2024;38(3):165-9.
Boudina M, Katsamakas M, Chorti A, et al. Diagnostic Accuracy of Ultrasound and Fine-Needle Aspiration Cytology in Thyroid Malignancy. Medicina. 2024;60(5):722.
Anwar K, Mohammad AY, Khan S. The sensitivity of TIRADS scoring on ultrasonography in the management of thyroid nodules. Pak J Med Sci. 2023;39(3):870-4.
Staibano P, Forner D, Noel CW, Zhang H, Gupta M, Monteiro E, et al. Ultrasonography and Fine-Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy. Laryngoscope. 2022;132(1):242-51.
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