, Volume 64, Issue 1, pp 90–96 | Cite as

Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules

  • Luying Gao
  • Xuehua Xi
  • Yuxin Jiang
  • Xiao Yang
  • Ying Wang
  • Shenling Zhu
  • Xingjian Lai
  • Xiaoyan Zhang
  • Ruina Zhao
  • Bo ZhangEmail author
Original Article



To compare the value of Thyroid Imaging Reporting and Data Systems proposed by Kwak (KWAK-TIRADS) and ACR (ACR TI-RADS) and 2015 American Thyroid Association (ATA) guidelines in the diagnosis of surgically resected thyroid nodules.


From January 2015 to December 2015, 2544 thyroid nodules in 1758 patients who underwent thyroidectomy at our center were included. The KWAK-TIRADS category, ACR TI-RADS and ultrasound (US) pattern based on ATA guidelines were assigned to each thyroid nodule. Nodules were divided into groups according to their maximal diameter further.


Of all the nodules, 863 (33.9%) were benign, whereas 1681 (66.1%) were malignant. The malignancy percentage of ACR TI-RADS category 1, 2, 3, 4, and 5 were 0%, 1.3%, 9.1%, 52.5%, and 88.8%, respectively. KWAK-TIRADS and ATA guidelines showed a better diagnostic efficiency than ACR TI-RADS (P < 0.01). ACR TI-RADS demonstrated a higher specificity (79.7%, P < 0.05), whereas the ATA US pattern had a higher sensitivity (95.5%, P < 0.01). The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines performed better in differentiating nodules >1 cm. KWAK-TIRADS showed better diagnostic efficiency than the other methods in differentiating nodules >1 cm (AUC: 0.92, P < 0.01).


KWAK-TIRADS and ATA guidelines provide a better diagnostic efficiency than ACR TI-RADS. The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines perform better in differentiating nodules >1 cm than nodules ≤1 cm. KWAK-TIRADS perform better in differentiating nodules >1 cm than other methods.


Thyroid nodules Ultrasound 2015 American Thyroid Association management guideline Thyroid Imaging Reporting and Data System 



This study was supported by a grant from the National International Science and Technology Cooperation Project (2015DFA 30440).

Author contributions

L.G. and X.X. participated in the study design, performed the statistical analysis, and drafted the manuscript. Y.J. conceived of the study, participated in its design. X.Y., Y.W., S.Z., R.Z., X.L., and X.Z. carried out the selection and collection of samples. B.Z. participated in the study design, performed the statistical analysis, and review the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, and the requirement for informed consent was waived for this retrospective study.

Supplementary material

12020_2019_1843_MOESM1_ESM.docx (13 kb)
Supplementary Information


  1. 1.
    G.H. Tan, H. Gharib, Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann. Intern. Med. 126, 226–231 (1997)CrossRefGoogle Scholar
  2. 2.
    S. Guth, U. Theune, J. Aberle, A. Galach, C.M. Bamberger, Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur. J. Clin. Invest. 39, 699–706 (2009)CrossRefGoogle Scholar
  3. 3.
    L. Hegedüs, The thyroid nodule. NEJM 351, 1764–1771 (2004)CrossRefGoogle Scholar
  4. 4.
    L. Leenhardt, M.F. Erdogan, L. Hegedus, S.J. Mandel, R. Paschke et al. European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur. Thyroid J. 2, 147–59 (2013)CrossRefGoogle Scholar
  5. 5.
    G.H. Tan, H. Gharib, Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann. Intern Med. 126, 226–231 (1997)CrossRefGoogle Scholar
  6. 6.
    P. Perros, K. Boelaert, S. Colley, C. Evans, R.M. Evans et al. Guidelines for the management of thyroid cancer. Clin. Endocrinol. 81, 1–122 (2014)CrossRefGoogle Scholar
  7. 7.
    J.H. Shin, J.H. Baek, J. Chung, E.J. Ha, J.H. Kim et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J. Radiol. 17, 370–395 (2016)CrossRefGoogle Scholar
  8. 8.
    H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr. Pract. 22, 622–639 (2016)CrossRefGoogle Scholar
  9. 9.
    J.Y. Kwak, K.H. Han, J.H. Yoon, H.J. Moon, E.J. Son et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 260, 892–899 (2011)CrossRefGoogle Scholar
  10. 10.
    B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel et al. American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2015)CrossRefGoogle Scholar
  11. 11.
    F.N. Tessler, W.D. Middleton, E.G. Grant, J.K. Hoang, L.L. Berland et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J. Am. Coll. Radiol. 14, 587–595 (2017)CrossRefGoogle Scholar
  12. 12.
    W.D. Middleton, S.A. Teefey, C.C. Reading, J.E. Langer, M.D. Beland et al. Comparison of Performance Characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association Guidelines. Ajr Am. J. Roentgenol. 210, 1–7 (2018)CrossRefGoogle Scholar
  13. 13.
    J. Koh, S.Y. Kim, H.S. Lee, E.K. Kim, J.Y. Kwak et al. Diagnostic performances and interobserver agreement according to observer experience: a comparison study using three guidelines for management of thyroid nodules. Acta Radiol. 59, 028418511774400 (2017)Google Scholar
  14. 14.
    T. Xu, J.Y. Gu, X.H. Ye, S.H. Xu, Y. Wu et al. Thyroid nodule sizes influence the diagnostic performance of TIRADS and ultrasound patterns of 2015 ATA guidelines: a multicenter retrospective study. Sci. Rep. 7, 43183 (2017)CrossRefGoogle Scholar
  15. 15.
    X. Wei, Y. Li, S. Zhang, M. Gao, Meta-analysis of thyroid imaging reporting and data system in the ultrasonographic diagnosis of 10,437 thyroid nodules. Head Neck 38, 309–315 (2016)CrossRefGoogle Scholar
  16. 16.
    E.J. Ha, D.G. Na, W.J. Moon, Y.H. Lee, N. Choi, Diagnostic performance of ultrasound-based risk-stratification systems for thyroid nodules: comparison of the 2015 American Thyroid Association guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American Congress of Radiology Guidelines. Thyroid 28, 1532–1537 (2018)CrossRefGoogle Scholar
  17. 17.
    G. Grani, L. Lamartina, V. Ascoli, D. Bosco, M. Biffoni et al. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: toward the “right” TIRADS. J. Clin. Endocrinol. Metab. 104, 95–102 (2019)Google Scholar
  18. 18.
    S.P. Cheng, J.J. Lee, J.L. Lin, S.M. Chuang, M.N. Chien et al. Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head. Neck. 35, 541–547 (2013)CrossRefGoogle Scholar
  19. 19.
    J.H. Yoon, H.S. Lee, E.K. Kim, H.J. Moon, J.Y. Kwak, Malignancy risk stratification of thyroid nodules: comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association Management guidelines. Radiology 278, 917 (2016)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UltrasoundChinese Academy of Medical Sciences & Peking Union Medical College HospitalBeijingChina

Personalised recommendations