Reliability of Thyroid Imaging Reporting and Data System (TIRADS) Classification in Differentiating Benign from Malignant Thyroid Nodules


Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRADS) classifications have been developed with main goal to standardize reporting and facilitate communication between practitioners, and to indicate when fine-needle aspiration biopsy (FNAB) should be performed. Objective: To determine the reliability of Russ’ modified TIRADS classification in predicting thyroid malignancy. Materials and Methods: It was a cross sectional study carried out at Centre Hospitalier de Lagny, Marne La Vallée (France). Consecutive records of patients with focal thyroid nodules on ultrasound (US) for which US-guided FNAB was performed and pathology results were available, from January 2007 to August 2012, were selected for review. The risk of malignancy of each TIRADS category was determined and correlation with pathology assessed. Statistical performances of some US features were also assessed. The threshold for statistical significance was set at 0.05. Results: A total of 430 records of patients were eligible. Twenty-three out of 430 (5.3%) nodules were malignant. The risk of malignancy of the TIRADS categories were as follows: TIRADS2 0%, TIRADS3 2.2%, TIRADS4A 5.9%, TIRADS4B 57.9%, TIRADS5 100% (Gamma statistic = 0.85; Spearman correlation = 0.30, Pearson’s R = 0.37, p < 0.001). Some US features were associated with a higher risk of malignancy: irregular contours (OR = 22.4), taller-than-wide shape (OR = 19.5), microcalcifications (OR = 15.2), and marked hypoechogenicity (OR = 12.7). Conclusion: Russ’ modified TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adoption and use.

Share and Cite:

B. Moifo, E. Takoeta, J. Tambe, F. Blanc and J. Fotsin, "Reliability of Thyroid Imaging Reporting and Data System (TIRADS) Classification in Differentiating Benign from Malignant Thyroid Nodules," Open Journal of Radiology, Vol. 3 No. 3, 2013, pp. 103-107. doi: 10.4236/ojrad.2013.33016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] L. E. Koike, S. Noguchi, H. Yamashita, T. Murakami, A. Ohshima, H. Kawamoto and H. Yamashita, “Ultrasono graphic Characteristics of Thyroid Nodules: Prediction of Malignancy,” Archives of Surgery, Vol. 136, No. 3, 2001, pp. 334-337. doi:10.1001/archsurg.136.3.334
[2] E. Papini, R. Guglielmi, A. Bianchini, A. Crescenzi, S. Taccogna, F. Nardi, C. Panunzi, R. Rinaldi, V. Toscano and C. M. Pacella, “Risk of Malignancy in Nonpalpable Thyroid Nodules: Predictive Value of Ultrasound and Color-Doppler Features,” The Journal of Clinical Endocrinology & Metabolism, Vol. 87, No. 5, 2002, pp. 1941-1946. doi:10.1210/jc.87.5.1941
[3] J. K. Hoang, W. K. Lee, M. Lee, D. Johnson and S. Farrell, “US Features of Thyroid Malignancy: Pearls and Pitfalls,” Radiographics, Vol. 27, No. 3, 2007, pp. 847-860. doi:10.1148/rg.273065038
[4] K. M. Kim, J. B. Park, S. J. Kang and K. S. Bae, “Ultrasonographic Guideline for Thyroid Nodules Cytology: Single Institute Experience,” Journal of the Korean Sur gical Society, Vol. 84, No. 2, 2013, pp. 73-79. doi:10.4174/jkss.2013.84.2.73
[5] J. Y. Kwak, K. H. Han, J. H. Yoon, H. J. Moon, E. J. Son, S. H. Park, et al., “Thyroid Imaging Reporting and Data System for Ultrasound Features of Nodules: A Step in Establishing Better Stratification of Cancer Risk,” Radiology, Vol. 260, No. 3, 2011, pp. 892-899. doi:10.1148/radiol.11110206
[6] E. K. Kim, C. S. Park, W. Y. Chung, K. K. Oh, D. I. Kim, et al., “New Sonographic Criteria for Recommending Fine-Needle Aspiration Biopsy of Nonpalpable Solid Nodules of the Thyroid,” American Journal of Roent genology, Vol. 178, No. 3, 2002, pp. 687-691. doi:10.2214/ajr.178.3.1780687
[7] M. C. Frates, C. B. Benson, J. W. Charboneau, E. S.Cibas, O.H. Clark, et al., “Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement,” Radiology, Vol. 237, No. 3, 2005, pp. 794-800. doi:10.1148/radiol.2373050220
[8] C. Capelli, M. Castellano, I. Pirola, D. Cumetti, B. Agosti, E. Gandossi and E. Agabiti Rosei, “The Predictive Value of Ultrasound Findings in the Management of Thyroid Nodules,” QJM: An International Journal of Medicine, Vol. 100, No. 1, 2007, pp. 29-35. doi:10.1093/qjmed/hcl121
[9] E. Horvath, S. Majlis, R. Rossi, C. Franco, J. P. Niedmann, et al., “An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management,” The Journal of Clinical Endocrinology & Metabolism, Vol. 95, No. 5, 2009, pp. 1748-1751. doi:10.1210/jc.2008-1724
[10] American College of Radiology, “Breast Imaging Reporting and Data System. Breast Imaging Atlas,” 4th Edition, American College of Radiology, Reston, 2003.
[11] J. Y. Park, H. J. Lee, H. W. Jang, H. K. Kim, J. H. Hi, et al., “A Proposal for a Thyroid Imaging Reporting and Data System for Ultrasound Features of Thyroid Carci noma,” Thyroid, Vol. 19, No. 11, 2009, pp. 1257-1264. doi:10.1089/thy.2008.0021
[12] G. Russ, C. Bigorgne, B. Royer, A. Rouxel and M. Bien venu-Perrard, “The Thyroid Imaging Reporting and Data System (TIRADS) for Ultrasound of the Thyroid,” Jour nal of Radiology, Vol. 92, No. 7-8, 2011, pp. 701-713. doi:10.1016/j.jradio.2011.03.022
[13] G. Russ, “Thyroid Imaging and Reporting Database Sys tem,” 2013.
[14] D. S. Dean and H. Gharib, “Epidemiology of Thyroid Nodules,” Best Practice & Research: Clinical Endocrinology & Metabolism, Vol. 22, No. 6, 2008, pp. 901-911. doi:10.1016/j.beem.2008.09.019
[15] H. J. Moon, J. M. Sung, E. K. Kim, J. H. Yoon, J. H. Youk and J. Y. Kwak, “Diagnostic Performance of Gray Scale US and Elastography in Solid Thyroid Nodules,” Radiology, Vol. 262, No. 3, 2012, pp. 1002-1013. doi:10.1148/radiol.11110839
[16] Y. J. Hong, E. J. Son, E. K. Kim, J. Y. Kwak, S. W. Hong, H. S. Chang, “Positive Predictive Values of Sonographic Features of Solid Thyroid Nodule,” Clinical Imaging, Vol. 34, No. 2, 2010, pp. 127-133. doi:10.1016/j.clinimag.2008.10.034
[17] J. Y. Kwak, I. Jung, J. H. Baek, S. M. Baek, N. Choi, Y. J. Choi, et al., “Image Reporting and Characterization System for Ultrasound Features of Thyroid Nodules: multicentrickorean Retrospective Study,” Korean Journal of Radiology, Vol. 14, No. 1, 2013, pp. 110-117.

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.