Diagnostic Performance of Five Societies’ Ultrasound Risk Stratification Systems for Thyroid Malignancy According to Nodule Size: A Comparison Using a Standardized Ultrasound Lexicon
Authors' conclusion
The five RSSs differed considerably in nodule classification, malignancy risk across categories, and diagnostic performance according to nodule size. The differences in diagnostic performance stem primarily from variations in biopsy size thresholds and US criteria for small nodules, and disparate US criteria for no-biopsy-indicated large nodules. Optimizing risk stratification and biopsy thresholds, particularly for large nodules, is required for establishing a unified TIRADS.
Study context
- Population
- Thyroid nodules >1 cm with final diagnoses, March 2017 to February 2024; small ≤2 cm, large >2 cm
- Participants
- 3,774 nodules
- Comparison
- American Thyroid Association (ATA) system vs EU-TIRADS vs K-TIRADS vs ACR TI-RADS vs C-TIRADS
- Outcome
- Diagnostic performance (sensitivity, unnecessary biopsy rate) based on biopsy criteria, by nodule size
Methodological detailsstandardized ultrasound (US) lexicon, comparison of five risk stratification systems (RSSs), US features assessed during real-time examinations; nodules retrospectively classified per each RSS
- Standardized US lexicon
- Comparison of five RSSs
- US features assessed during real-time examinations; nodules retrospectively classified per each RSS
Performance
As reported in the abstract
Sensitivity and unnecessary biopsy rate (UBR) by nodule size
- ATA and EU-TIRADS: higher sensitivity and unnecessary biopsy rate (UBR) in both small and large nodules
- ACR TI-RADS: lower sensitivity and UBR across both sizes
- K-TIRADS: lowest sensitivity and UBR for small nodules (all p < 0.001); high sensitivity and UBR for large nodules
- C-TIRADS: similarly low sensitivity but higher UBR vs ACR TI-RADS in both size groups (all p < 0.001)
Further findings
Distribution of classified nodules, malignant tumor distribution across categories, malignancy risk of most categories
- Inter-system agreement (κ)
- 0.05-0.85
- Significant differences among RSSs (all p < 0.001)
Original publication
Diagnostic Performance of Five Societies’ Ultrasound Risk Stratification Systems for Thyroid Malignancy According to Nodule Size: A Comparison Using a Standardized Ultrasound Lexicon. Thyroid. Published 6 March 2026. doi:10.
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