Practicability and Accuracy of Thyroid Imaging Reporting and Data System as a Tool to Stratify Cancer Risk in Patients with Thyroid Nodules

Background There is a high prevalence of thyroid nodules on ultrasonographic (US) examination. However, most of them are benign. Hence select US criteria may help to decide cost-effective management and avoid unnecessary invasive procedures. Aims and Objectives To use TIRADS as a practicable tool for stratification of cancer risk in thyroid nodules. To assess the overall accuracy of TIRADS in the diagnosis of patients with thyroid nodules by comparing with histopathological reports of FNAB. Design A cross-sectional study using the TIRADS, which is based on the concepts of the Breast Imaging Reporting Data System of the American College of Radiology. Materials and Methods Over a period of 24 months, 240 patients were referred to the department of Radiodiagnosis at Justice K. S. Hegde Charitable Hospital, Deralakatte, Mangalore for ultrasound evaluation of thyroid gland.55 of the 240 patients had nodules with suspicious ultrasound features as described in the TIRADS atlas and were included into the study. A correlation of the US findings and fine needle aspiration biopsy (FNAB) was studied and risk of malignancy was determined according to the number of suspicious US features. Results The following suspicious US features showed a significant association with malignancy solid composition, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. As the number of suspicious US features increased, the probability and risk of malignancy also increased. Positive predictive values according to the number of suspicious US features were significantly different. Conclusion Ultrasonography is the best diagnostic tool in the initial assessment of thyroid nodule. Given the appropriateness and accessibility, the ultrasound-based TIRADS allows for stratification of thyroid cancer risk by using the number of suspicious US features. The TIRADS allows to improve patient management and cost-effectiveness, by avoiding unnecessary FNAB. TIRADS is a practical, convenient and reliable tool suitable for widespread adoption and use.