DIAGNOSTIC ACCURACY OF TI-RADS CLASSIFICATION SYSTEM FOR MALIGNANT THYROID NODULES, KEEPING HISTOPATHOLOGY AS GOLD STANDARD

Authors

  • Fizza Tufail Ayub Teaching Hospital
  • Azmat Ali Associate Professor, Radiology Department, Ayub Medical Teaching Institution- Abbottabad.
  • Laila Khan Assistant Professor, Radiology Department, Mardan Medical Complex Mardan
  • Hamza Javed Resident Radiologist at Radiology department, Ayub Teaching Hospital- Abbottabad
  • Mahnoor Resident Radiologist at Radiology department, Ayub Teaching Hospital- Abbottabad

DOI:

https://doi.org/10.55519/JAMC-04-15018

Keywords:

Thyroid nodules, Malignancy, ACR TI-RADS, Ultrasonography, Diagnostic accuracy, Histopathology

Abstract

Background: Thyroid nodules is a common endocrine gland lesion. A significant number of them turn out to be malignant. Accurate and non-invasive risk stratification is essential to reduce unnecessary fine-needle aspirations and also to ensure early detection. Therefore, we aimed to determine the diagnostic accuracy of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in identifying malignant thyroid nodules, using histopathology as the gold standard. Methods: This cross-sectional validation study spanned from Sept 2024 to June 2025. It was conducted in the Department of Diagnostic Radiology, Ayub Teaching Hospital, Abbottabad. A total of 140 patients were enrolled with thyroid nodules detected on ultrasonography. Each nodule was scored according to TIRADS and compared with histopathology results. Validity parameters for ultrasonography taking histopathology as gold standard were calculated using 2x2 contingency. Results: Among the total 140 thyroid nodules that we studied, 48 (34.3%) were malignant and 92 (65.7%) were benign. Using TI-RADS ≥4 as a threshold for malignancy, the sensitivity was then 91.7%, specificity 85.0%, PPV 75.9%, NPV 95.1%, and overall diagnostic accuracy was of 88.6%. TIRADS showed statistically significant correlation with histopathology diagnosis (p <0.001).

Conclusion: ACR TIRADS has high validity, therefore is a reliable, non-invasive, diagnostic tools for malignant nodules. Its routine first line use can enhance diagnostic precision. It can also reduce unnecessary biopsies.

References

1. Cooper DS. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167–214.

2. Kung AW, Chau MT, Lao TT, Tam SC, Low LC. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab 2002;87(3):1010–4.

3. Hahn SY, Shin JH, Oh YL, Park KW. Ultrasound-guided core needle biopsy techniques for intermediate or low suspicion thyroid nodules: Which method is effective for diagnosis? Korean J Radiol 2019;20(10):1454–61.

4. Kamran M, Hassan N, Ali M, Ahmad F, Shahzad S, Zehra N. Frequency of thyroid incidentalomas in Karachi population. Pak J Med Sci 2014;30(4):793–7.

5. Hang Q, Ma J, Sun W, Zhang L. Comparison of Diagnostic Performance Between The American College of Radiology Thyroid Imaging Reporting And Data System And American Thyroid Association Guidelines: A Systematic Review. Endocr Pract 2020;26(5):552–63.

6. Ali A, Mirza Y, Faizan U, Zahid N, Awan MS. Association of obesity and thyroid cancer at a tertiary care hospital in Pakistan. Cureus 2018;10(3):e2364.

7. Alexander EK, Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol 2022;10(7):533–9.

8. Kim DH, Chung SR, Choi SH, Kim KW. Accuracy of thyroid imaging reporting and data system category 4 or 5 for diagnosing malignancy: a systematic review and meta- analysis. Eur Radiol 2020;30(10):5611–24.

9. Thattarakkal VR, Ahmed TSF, Saravanam PK, Murali S. Evaluation of Thyroid Nodule: Thyroid Imaging Reporting and Data System (TIRADS) and Clinicopathological Correlation. Indian J Otolaryngol Head Neck Surg 2022;74(3):5850–6.

10. Singaporewalla RM, Seet BWS, Rao AD, Kotamma V. A 3-year comparative audit of thyroid nodule ultrasound and cytology using TIRADS and Bethesda scoring systems. World J Endocr Surg 2021;13(3):75–80.

11. Bujang MA. An elaboration on sample size planning for performing a one-sample sensitivity and specificity analysis by basing on calculations on a specified 95% confidence interval width. Diagnostics 2023;13(8):1390.

12. Li W, Wang Y, Wen J, Zhang L, Sun Y. Diagnostic performance of American College of Radiology TI-RADS: a systematic review and meta-analysis. AJR Am J Roentgenol 2021;216(1):38–47.

13. Kang YJ, Stybayeya G, Lee JE, Hwang SH. Diagnostic performance of ACR and Kwak TI-RADS for benign and malignant thyroid nodules: an updated systematic review and meta-analysis. Cancers (Basel) 2022;14(23):5961.

14. Anwar K, Mohammad AY, Khan S. The sensitivity of TIRADS scoring on ultrasonography in the management of thyroid nodules. Pak J Med Sci 2023;39(3):870–4.

15. Saqib H, Saeed U, Zahra M, Noreen A, Firdous A, Islam Z. Diagnostic accuracy of TI-RADS classification in differentiating benign and malignant thyroid nodules keeping fine needle aspiration cytology (FNAC) as gold standard. Biol Clin Sci Res J 2024;3(1):742.

16. Mustansar N, Khan AA, Khan Y, Javaid K, Jarral WY, Khan NU. Ultrasound risk stratification of thyroid nodules: comparative accuracy of TI-RADS in predicting malignancy. Int J Biomed Clin Res 2025;4(1):1–3.

17. Zhu C, Zhong L, Lin M, Tian C, Wang C. The value of TI-RADS combined with superb microvascular imaging in distinguishing benign and malignant thyroid nodules: a meta-analysis. PLoS One 2022;17(1):e0261521.

18. Ferris RL, Baloch Z, Bernet V, Chen A, Fahey TJ 3rd, Ganly I, et al . American Thyroid Association statement on surgical application of molecular profiling for thyroid nodules: current impact on perioperative decision making. Thyroid 2015;25(7):760–8.

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Published

2026-06-29

How to Cite

1.
Fizza Tufail, Ali A, Khan L, Javed H, Mahnoor. DIAGNOSTIC ACCURACY OF TI-RADS CLASSIFICATION SYSTEM FOR MALIGNANT THYROID NODULES, KEEPING HISTOPATHOLOGY AS GOLD STANDARD. J Ayub Med Coll Abbottabad [Internet]. 2026 Jun. 29 [cited 2026 Aug. 13];37(4). Available from: https://www.demo.ayubmed.edu.pk/index.php/jamc/article/view/15018

Issue

Vol. 37 No. 4 (2025): 37-4

Section

ORIGINAL ARTICLE

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Copyright (c) 2026 Fizza Tufail, Azmat Ali, Laila Khan, Hamza Javed, Mahnoor

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