Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules
To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness.
Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated.
The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3–60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4–5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9–100.0), specificity 74.35 % (95 % CI: 68.7–80.0), PPV 82.1 % (95 % CI: 78.0–86.3), NPV 99.4 % (95 % CI: 98.3–100.0), PLR 3.9 (95 % CI: 3.6–4.2) and an NLR 0.005 (95 % CI: 0.003–0.04) for malignancy.
US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk.
• TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4–5).
• The recognition of benign/possibly benign patterns can avoid unnecessary procedures.
• This classification and its sonographic patterns are validated using surgical specimens.
KeywordsThyroid nodule Thyroid neoplasm Ultrasound Risk classification Thyroid cancer
Fine needle aspiration biopsy
Positive predictive value
Negative predictive value
Positive likelihood ratio
Negative likelihood ratio
The scientific guarantor of this publication is Eleonora Horvath MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board.
Methodology: retrospective, diagnostic or prognostic study performed at one institution.
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