An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management.
BACKGROUND
There is a high prevalence of thyroid nodules on ultrasonographic (US) examination. However, most of them are benign. US criteria may help to decide cost-effective management.


OBJECTIVE
Our objective was to develop a standardized US characterization and reporting data system of thyroid lesions for clinical management: the Thyroid Imaging Reporting and Data System (TIRADS).


METHODS
This was a prospective study using the TIRADS, which is based on the concepts of the Breast Imaging Reporting Data System of the American College of Radiology.


METHODS
A correlation of the US findings and fine needle aspiration biopsy (FNAB) results in 1959 lesions biopsied under US guidance and studied histologically during an 8-yr period was divided into three stages. In the first stage, 10 US patterns were defined. In the second stage, four TIRADS groups were defined according to risk. The percentages of malignancy defined in the Breast Imaging Reporting and Data System were followed: TIRADS 2 (0% malignancy), TIRADS 3 (<5% malignancy), TIRADS 4 (5-80% malignancy), and TIRADS 5 (>80% malignancy).


RESULTS
The TIRADS classification was evaluated at the third stage of the study in a sample of 1097 nodules (benign: 703; follicular lesions: 238; and carcinoma: 156). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88, 49, 49, 88, and 94%, respectively. The ratio of benign to malignant or follicular FNAB results currently is 1.8.


CONCLUSIONS
The TIRADS has allowed us to improve patient management and cost-effectiveness, avoiding unnecessary FNAB. In addition, we have established standard codes to be used both for radiologists and endocrinologists.
Horvath
Eleonora
E
Thyroid Board, Clinica Alemana de Santiago, Av. Vitacura 5951 Santiago, Chile.
Majlis
Sergio
S
Rossi
Ricardo
R
Franco
Carmen
C
Niedmann
Juan P
JP
Castro
Alex
A
Dominguez
Miguel
M
D044963:Biopsy, Fine-Needle; D018265:Carcinoma, Papillary, Follicular / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography