Is TIRADS a practical and accurate system for use in daily clinical practice?

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Abstract

Aim:

To assess the positive predictive value (PPV) and inter-observer agreement of Thyroid Imaging Reporting and Data System (TIRADS) as described by Kwak et al.

Materials and Methods:

This was a prospective study wherein ultrasound was performed by two radiologists on patients with thyroid nodules >1 cm. The third radiologist interpreted archived images. Ultrasound features and TIRADS category were compared with cytology and surgical histopathology. PPV was calculated for all readers’ combined assessment. Inter-observer agreement was calculated using linear weighted kappa.

Results:

A total of 238 patients with 272 nodules of mean size 2.9 ± 1.7 cm were included. PPV for malignancy was 6.6%, 32%, 36%, 64%, 59%, and 91% for TIRADS 2, 3, 4a, 4b, 4c, and 5 categories, respectively. Inter-observer agreement was substantial [kappa (k) = 0.61-0.80] for assessment of nodule echogenicity, margins, calcification, and shape and good (k = 0.570, P < 0.001) for assessment of composition of the thyroid nodules. Overall agreement between observers was substantial for assigning TIRADS category [multi-rater weighted kappa coefficient (wt k) = 0.721, P < 0.001].

Conclusions:

TIRADS is a simple and practical method of assessing thyroid nodules with high PPV and good inter-observer agreement.

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Most cited references 14

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New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid.

Eun-Kyung Kim, Cheong Soo Park, Woung Chung … (2002)

The purpose of our study was to provide new sonographic criteria for fine-needle aspiration biopsy of nonpalpable solid thyroid nodules. Sonographic scans of 155 nonpalpable thyroid nodules in 132 patients were prospectively classified as having positive or negative findings. Sonographic findings that suggested malignancy included microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as positive (malignant). If a nodule had none of the features described, it was classified as negative (benign). The final diagnosis of a lesion as benign (n = 106) or malignant (n = 49) was confirmed by fine-needle aspiration biopsy and follow-up (>6 months) in 83 benign nodules, by fine-needle aspiration biopsy and surgery in 44 malignant and 15 benign lesions, and by surgery alone in five malignant and eight benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated on the basis of our proposed classification method. Of 82 lesions classified as positive, 46 were malignant. Of 73 lesions classified as negative, three were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 93.8%, 66%, 56.1%, 95.9%, and 74.8%, respectively. Considering the high level of sensitivity of our proposed sonographic classification, fine-needle aspiration biopsy should be performed on thyroid nodules classified as positive, regardless of palpability.

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A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma.

S. H. Kim, Colin J Yi, Ok Park … (2009)

Several thyroid ultrasound (TUS) findings have been associated with an increased risk for thyroid cancer; however, there is no consensus as to the format and style for reporting the results of TUS. The objective of this study was to discover the features indicative of malignancy in thyroid nodules based on TUS, generate an equation using these features that would be predictive of malignancy in thyroid nodules, and stratify the results of this equation into TUS categories reflecting the probability of malignancy. We obtained odds ratios of TUS findings indicative of malignancy and probability of malignancy for each nodule as determined by logistic regression analysis of ultrasound (US) findings in 1694 patients who had US-guided fine-needle aspiration biopsy. We then generated an equation to predict the probability of malignancy based on TUS and developed categories ranging from lowest to highest probability of malignancy. We evaluated the reliability of this equation and the categories using cytology and histopathology information regarding malignancy in the thyroid nodules. We characterized 12 aspects of thyroid nodules as seen on TUS and developed an equation to predict P(us), the probability of a nodule being malignant based on these US findings. The equation was P(us) = 1/(1 + e(-z)), where e is the mathematical constant 2.71828 and z is the logit of malignant thyroid nodule. P(us) was stratified into five categories based on the probability of a nodule being malignant as indicated by the findings (TUS 1, benign; TUS 2, probably benign; TUS 3, indeterminate; TUS 4, probably malignant; TUS 5, malignant). There was a significant correlation between the cytological category and the TUS 1 through TUS 5 categories (r = 0.491, p < 0.001). We propose an equation to predict the probability of malignancy in thyroid nodules based on 12 features of thyroid nodules as noted on TUS. This equation, and the stratification of its results into categories, should be useful in reporting the findings of US for thyroid nodules and in guiding management decisions.

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High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population.

V Usha Menon, K R Sundaram, A. G. Unnikrishnan … (2009)

India is in the transition phase from iodine deficiency to iodine sufficiency, and this is expected to change the thyroid status of the population. The thyroid status and auto-immune status of adult Indian population in the postiodisation phase is largelyunknown, and this study was conducted to answer this question. A cross-sectional population survey was conducted in two phases among the residents of urban coastal area of central Kerala. The initial phase included a house-to-house survey of 3069 adults (>18 years of age), selected by cluster sampling method. From the surveyed population, 986 subjects underwent further physical examination and biochemical evaluation for thyroid function, thyroid autoimmunity status and iodine status. The total prevalence of goitre was 12.2% and median urine iodine excretion was 211.4 mcg/l (mean 220.3 +/- 99.5 mcg/l) indicating iodine sufficiency. Thyroid function abnormalities were present in 19.6% of subjects. Subclinical hypothyroidism was present in 9.4%. Among the population with normal thyroid function, 9.5% and 8.5% respectively had positive anti-TPO and anti-TG antibodies. Among those with thyroid dysfunction, 46.3% had positive anti-TPO and 26.8% were anti-TG positive. A significant proportion of this iodine-sufficient adult population had thyroid disorders. Further studies are required to characterise the reasons for this high prevalence. Iodine deficiency as well as thyroid dysfunction should both be the focus of public health strategies in susceptible populations.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Radiol Imaging

Journal ID (iso-abbrev): Indian J Radiol Imaging

Journal ID (publisher-id): IJRI

Title: The Indian Journal of Radiology & Imaging

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-3026

ISSN (Electronic): 1998-3808

Publication date (Print): Jan-Mar 2016

Volume: 26

Issue: 1

Pages: 145-152

Affiliations

[1]Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India

[1 ]Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India

[2 ]Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India

[3 ]Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Author notes

Correspondence: Dr. Anuradha Chandramohan, Department of Radiology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E-mail: anuradhachandramohan@ 123456gmail.com

Article

Publisher ID: IJRI-26-145

DOI: 10.4103/0971-3026.178367

PMC ID: 4813066

PubMed ID: 27081240

SO-VID: fbe7ab4c-b6f4-4bf7-9d9b-be34bdcd8270

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Is TIRADS a practical and accurate system for use in daily clinical practice?

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Abstract

Aim:

Materials and Methods:

Results:

Conclusions:

Related collections

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Most cited references 14

New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid.

A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma.

High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population.

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