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Exp Clin Endocrinol Diabetes 2025; 133(02): 98-104
DOI: 10.1055/a-2498-7952
Article

Comparison of Diagnostic Performances of ATA Guidelines, ACR-TIRADS, and EU-TIRADS and Modified K-TIRADS: A Single Center Study of 4238 Thyroid Nodules

Mustafa Özdemir 
1   Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey (Ringgold ID: RIN175678)
,
Gamze Türk 
2   Department of Radiology, Kayseri City Hospital, Kayseri, Turkey (Ringgold ID: RIN147026)
,
Mustafa Bilgili 
2   Department of Radiology, Kayseri City Hospital, Kayseri, Turkey (Ringgold ID: RIN147026)
,
Ebru Akay 
3   Department of Pathology, Kayseri City Hospital, Kayseri, Turkey (Ringgold ID: RIN147026)
,
Ali Koç 
2   Department of Radiology, Kayseri City Hospital, Kayseri, Turkey (Ringgold ID: RIN147026)
› Author Affiliations Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
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Abstract

Objectives

Several ultrasound-based risk stratification systems (RSSs) have been developed and introduced into clinical practice for managing thyroid nodules. However, there are essential differences among these systems. This study aimed to determine and compare the category-based diagnostic performance of four ultrasound-based risk stratification systems in the detection of thyroid cancer: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS.

Methods

This study included 4238 nodules sampled by fine-needle aspiration biopsy between January 2018 and December 2021. Nodules were classified according to ultrasound imaging features and correlated with biopsy results. The diagnostic success of the risk stratification systems was evaluated and compared.

Results

Of the 4238 nodules, 3861 (91.1%) were benign and 376 (8.9%) were malignant. Malignancy was significantly higher in hypoechoic and marked hypoechoic nodules (p=0.001), and solid nodules (p=0.002). For detection of malignancy, areas under the receiving operator characteristics curves were 0.862, 0.850, 0.842, and 0.835 for 2017 ACR-TIRADS, EU-TIRADS, for K-TIRADS, and 2015 American Thyroid Association guidelines, respectively. EU-TIRADS showed the highest sensitivity (91%), whereas ACR-TIRADS had the highest specificity (87%). Compared to other risk stratification systems, ACR-TIRADS resulted in significantly fewer unnecessary biopsies (p=0.009).

Conclusion

All RSSs show high diagnostic accuracy and have their own advantages and disadvantages. When selecting an appropriate RSS, the population, the prevalence of the disease, and gender distribution should be considered.

Keywords

thyroid nodules - fine-needle aspiration - ultrasound - TIRADS classification


Publication History

Received: 09 September 2024

Accepted after revision: 09 December 2024

Accepted Manuscript online:
09 December 2024

Article published online:
29 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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