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

 

PDF Download Permissions and Reprints

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.

Publication History

Article published online:
30 July 2021

© 2016. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

• References

• 1 Usha Menon V, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H. High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population. J Indian Med Assoc 2009;107:72-7.
• 2 Brahmbhatt SR, Brahmbhatt RM, Boyages SC. Impact of protein energy malnutrition on thyroid size in an iodine deficient population of Gujarat (India): Is it an aetiological factor for goiter? Eur J Endocrinol 2001;145:11-7.
• 3 Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15(Suppl 2):S78-81.
• 4 Choi N, Moon WJ, Lee JH, Baek JH, Kim DW, Park SW. Ultrasonographic findings of medullary thyroid cancer: Differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 2011;52:312-6.
• 5 Hong YJ, Son EJ, Kim EK, Kwak JY, Hong SW, Chang HS. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging 2010;34:127-33.
• 6 Kim DW, Lee EJ, Jung SJ, Ryu JH, Kim YM. Role of sonographic diagnosis in managing Bethesda class III nodules. AJNR Am J Neuroradiol 2011;32:2136-41.
• 7 Kim DW, Lee YJ, Eom JW, Jung SJ, Ha TK, Kang T. Ultrasound-based diagnosis for solid thyroid nodules with the largest diameter <5 mm. Ultrasound Med Biol 2013;39:1190-6.
• 8 Kim DW, Park JS, In HS, Choo HJ, Ryu JH, Jung SJ. Ultrasound-based diagnostic classification for solid and partially cystic thyroid nodules. AJNR Am J Neuroradiol 2012;33:1144-9.
• 9 Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-91.
• 10 Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al.; Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 2008;247:762-70.
• 11 Lee MJ, Kim EK, Kwak JY, Kim MJ. Partially cystic thyroid nodules on ultrasound: Probability of malignancy and sonographic differentiation. Thyroid 2009;19:341-6.
• 12 Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid 2009;19:1257-64.
• 13 Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009;94:1748-51.
• 14 Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, et al.; Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Image reporting and characterization system for ultrasound features of thyroid nodules: Multicentric Korean retrospective study. Korean J Radiol 2013;14:110-7.
• 15 Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology 2011;260:892-9.
• 16 Hambly NM, Gonen M, Gerst SR, Li D, Jia X, Mironov S, et al. Implementation of evidence-based guidelines for thyroid nodule biopsy: A model for establishment of practice standards. AJR Am J Roentgenol 2011;196:655-60.
• 17 Mendelson EB, Böhm-Vélez M, Berg WA, et al. ACR BI-RADS ® Ultrasound. In: ACR BI-RADS ® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013.
• 18 Cibas ES, Ali SZ. The bethesda system for reporting thyroid cytopathology. Thyroid 2009;19:1159-65.
• 19 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
• 20 Chandramohan A, Khurana A, B Pushpa, A Deepak, P MJ. Positive predictive value and inter-observer agreement of TI-RADS for ultrasound features of thyroid nodules. Scientific Exhibit, ECR 2014. DOI: 10.1594/ecr2014/C-0594, DOI link:dx.doi.org/10.1594/ecr2014/C-0594.