Fine needle aspiration biopsy indications for thyroid nodules: compare a point-based risk stratification system with...

Area of Science:

• Radiology
• Endocrinology
• Oncology

Background:

• Thyroid nodules are common, and accurate risk stratification is crucial for appropriate management.
• Current guidelines, including the American College of Radiology thyroid image reporting and data system (ACR TI-RADS) and the American Thyroid Association (ATA) guidelines, aim to standardize the assessment of thyroid nodules.

Purpose of the Study:

• To compare the diagnostic performance of ACR TI-RADS and ATA guidelines in assessing thyroid nodules.
• To evaluate the reliability of ACR TI-RADS versus ATA guidelines in recommending fine needle aspiration biopsy (FNAB).

Main Methods:

• A retrospective study of 1001 thyroid nodules in 918 patients was conducted.
• Ultrasound features were reviewed and classified using both ACR TI-RADS and ATA guidelines.
• Diagnostic performance metrics and biopsy recommendations were compared between the two guideline systems.

Main Results:

• ACR TI-RADS demonstrated higher accuracy (84.9%) compared to ATA guidelines (48.7%) in differentiating malignant from benign nodules.
• The area under the curve (AUC) for ACR TI-RADS (0.935) was significantly greater than for ATA guidelines (0.884).
• ACR TI-RADS showed a higher biopsy yield of malignancy (59.5% vs. 38.5%) and a lower unnecessary FNAB rate (40.5% vs. 61.5%) compared to ATA guidelines.

Conclusions:

• ACR TI-RADS is more accurate than ATA guidelines for differentiating malignant thyroid nodules.
• ACR TI-RADS is more reliable for recommending thyroid nodules for FNAB, leading to a more efficient biopsy strategy.
• Ultrasound-based risk stratification using ACR TI-RADS improves diagnostic accuracy and reduces unnecessary procedures.