Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules
Authors' conclusion
These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.
Study context
- Population
- Patients who underwent thyroid US and US-guided thyroid fine-needle aspiration cytology (FNAC), Singapore General Hospital Outpatient Otolaryngology clinic, March–May 2021; 83% women, mean age 60 years630 nodules
- Participants
- 446 patients
- Exposure
- ACR TI-RADS classification vs Bethesda classification and histopathology
- Outcome
- Concordance of ACR TI-RADS FNAC recommendations with Bethesda scores and/or histopathology
Methodological detailssingle-centre, Data analysis performed in May 2021
- Single-centre
- Data analysis performed in May 2021
Main finding
As reported in the abstract
| Group | PPV vs Bethesda | PPV vs histopathology | NPV vs Bethesda | NPV vs histopathology |
|---|---|---|---|---|
| TI-RADS 3 | — not stated in the abstract | — not stated in the abstract | 94.6% (95% CI, 92.9%-95.9%; P < .001) | 100.0% (95% CI, 15.8%-100.0%; P = .003) |
| TI-RADS 4 | 2.8% | 6.1% | — not stated in the abstract | — not stated in the abstract |
| TI-RADS 5 | 16.2% | 66.7% | — not stated in the abstract | — not stated in the abstract |
PPV vs Bethesda
TI-RADS 3— not stated in the abstract
TI-RADS 42.8%
TI-RADS 516.2%
PPV vs histopathology
TI-RADS 3— not stated in the abstract
TI-RADS 46.1%
TI-RADS 566.7%
NPV vs Bethesda
TI-RADS 394.6% (95% CI, 92.9%-95.9%; P < .001)
TI-RADS 4— not stated in the abstract
TI-RADS 5— not stated in the abstract
NPV vs histopathology
TI-RADS 3100.0% (95% CI, 15.8%-100.0%; P = .003)
TI-RADS 4— not stated in the abstract
TI-RADS 5— not stated in the abstract
— not stated in the abstract
- Nodules benign on FNAC (Bethesda II)
- 492 of 630 (78.1%)
Observational data: associations, not effects.
Further findings
| Outcome | TI-RADS 4 | TI-RADS 5 |
|---|---|---|
| Malignant risk of small (<1.5 cm) nodules not recommended for FNAC, on Bethesda 5 and 6 | 5.7% | 25.0% |
| Malignancy confirmed on surgical excision | 10.9% | 71.4% |
| Denominator | 46 | 21 |
| Histopathology-proven cancer among nodules initially not recommended for FNAC | 30.7% | 50.0% |
| Denominator | 13 | 6 |
Original publication
Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules. JAMA Netw Open. Published 5 September 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →