A systematic review and meta-analysis of the Kwak TIRADS for the diagnostic assessment of indeterminate thyroid nodules

Abstract

Aim: To explore the diagnostic usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) classification proposed by Kwak in indeterminate nodules using a systematic literature review.

Material and methods: The PubMed, Cochrane database, ScienceDirect, and EMBASE databases were searched for relevant articles. A meta-analysis was performed to calculate pooled sensitivity, specificity, negative and positive likelihood ratios (LR- and LR+), diagnostic odds ratio (DOR), and area under the curve (AUC) from summarised receiver operating characteristic (SROC) curves.

Results: Six publications describing 1,096 nodules were analysed. Overall pooled sensitivity, specificity, LR+, LR-, DOR, and AUC for SROC were 0.913, 0.347, 1.396, 0.341, 5.832, and 0.7180, respectively.

Conclusions: Kwak TIRADS classification with 3/4a cut-off for indeterminate lesions has high sensitivity but low specificity to exclude benign lesions. A higher Kwak TIRADS cut-off could help exclude larger numbers of benign lesions and lower the rate of unnecessary surgeries.