A Modified Thyroid Imaging Reporting and Data System (mTI-RADS) For Thyroid Nodules in Coexisting Hashimoto's...

Area of Science:

• Radiology
• Oncology
• Endocrinology

Background:

• Hashimoto's thyroiditis (HT) complicates thyroid nodule evaluation.
• Accurate risk stratification is crucial for managing thyroid nodules in HT patients.
• Existing systems may require modification for HT-specific nuances.

Purpose of the Study:

• To develop and validate a modified Thyroid Imaging Reporting and Data System (mTI-RADS) using conventional ultrasound (US).
• To stratify malignancy risk for thyroid nodules in patients with coexisting Hashimoto's thyroiditis.
• To assess the performance of identified US features in predicting malignancy.

Main Methods:

• Retrospective analysis of 138 malignant and 292 benign thyroid nodules confirmed by pathology.
• Development of a risk score (RS) based on significant US features: marked hypoechogenicity, taller-than-wide shape, poorly-defined margin, calcifications, and halo sign absence.
• Establishment of mTI-RADS categories (3, 4a, 4b, 4c, 5) based on total RS.

Main Results:

• Significant US predictors of malignancy included marked hypoechogenicity, taller-than-wide shape, poorly-defined margin, calcifications, and absent halo sign (all P < 0.05).
• Malignancy rates increased progressively across mTI-RADS categories: 3.7% (Cat 3), 19.3% (Cat 4a), 38.1% (Cat 4b), 62.7% (Cat 4c), and 94.1% (Cat 5).
• Significant differences in malignancy rates were observed among mTI-RADS categories (P < 0.001).

Conclusions:

• The developed mTI-RADS effectively stratifies thyroid nodule malignancy risk in patients with Hashimoto's thyroiditis.
• This modified system may aid in guiding subsequent treatment decisions for thyroid nodules in HT patients.
• Conventional ultrasound features, when integrated into the mTI-RADS, provide valuable risk assessment.