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 Jan:117:110366. doi: 10.1016/j.clinimag.2024.110366. Epub 2024 Nov 22.

Abstract

Purpose: To compare the diagnostic performance of six different currently available guidelines including the American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS, Korean TIRADS (K-TIRADS), European TIRADS (EU-TIRADS), American Thyroid Association (ATA) and Chinese TIRADS (C-TIRADS), in differentiating malignant from benign thyroid nodules (TN).

Materials and methods: In this single-center study, between January-2007 and September-2023, ultrasound (US) images of TNs that were pathologically proven either by surgery or by fine needle aspiration biopsy (FNAB), were retrospectively evaluated and categorized according to six different currently available guidelines. Area under curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and miss rates for malignancy (MRM) were calculated for each guideline.

Results: A total of 829 TNs (n = 234 malignant and n = 595 benign) were included. AUC, sensitivity, specificity, PPV, NPV and accuracy for ACR-TIRADS were 0.786, 99.8 %, 27.1 %, 31.92 %, 99.73 % and 54.6 %, respectively; for Kwak-TIRADS 0.839, 97.8 %, 42.1 %, 36.29 %, 98.11 % and 63.1 %, respectively; for K-TIRADS 0.797, 97.6 %, 41.6 %, 36.01 %, 84.85 % and 62.8, respectively, for EU-TIRADS 0.766, 97.8 %, 35.6 %, 33.89 %, 97.92 % and 59.1 %, respectively, for ATA 0.788, 97.5 %, 49.8 %, 32.86 %, 88.16 % and 64.2 %, respectively and for C-TIRADS 0.842, 0 %, 92.8 %, 54.3 %, 39.53 %, 90.42 %, and 68.8 % respectively. MRM regarding ACR-/Kwak-/K-/EU-/ATA-/C-TIRADS were 2.2 %, 0.5 %, 2.9 %, 2.5 %, 3.3 % and 0.1 %, respectively.

Conclusion: Six different currently available TIRADS guidelines can provide effective differentiation of malignant TNs from benign ones with similar diagnostic performances. However; C-TIRADS offered the highest AUC and the lowest MRM than the other guidelines, in this series.

Keywords: Fine-needle aspiration biopsy; Guideline; Thyroid Imaging Reporting and Data System; Thyroid nodules; Ultrasound.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Biopsy, Fine-Needle
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Radiology Information Systems / standards
  • Retrospective Studies
  • Sensitivity and Specificity*
  • Thyroid Gland / diagnostic imaging
  • Thyroid Gland / pathology
  • Thyroid Neoplasms / diagnostic imaging
  • Thyroid Neoplasms / pathology
  • Thyroid Nodule* / diagnostic imaging
  • Thyroid Nodule* / pathology
  • Ultrasonography* / methods