Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

Ashkan Torshizian; Fatemeh Hashemi; Nastaran Khoshhal; Alireza Ghodsi; Houra Rastegar; Zohreh Mousavi; Maliheh Dadgar Moghadam; Masoud Mohebbi

doi:10.3390/diagnostics13182972

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

Diagnostics (Basel). 2023 Sep 18;13(18):2972. doi: 10.3390/diagnostics13182972.

Authors

Ashkan Torshizian¹, Fatemeh Hashemi¹, Nastaran Khoshhal¹, Alireza Ghodsi¹, Houra Rastegar¹, Zohreh Mousavi², Maliheh Dadgar Moghadam³, Masoud Mohebbi^{2

4}

Affiliations

¹ Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran.
² Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran.
³ Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran.
⁴ Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq., Mashhad 13944-91388, Iran.

Abstract

Aim: This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy.

Methods: The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

Results: Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77).

Conclusions: Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.

Keywords: ACR TI-RADS; ATA guidelines; malignancy; thyroid nodule.

Grants and funding

This research received no external funding.