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A DIRECT COMPARISON OF THE ATA AND TI-RADS ULTRASOUND SCORING SYSTEMS.

Sara Ahmadi, Taofik Oyekunle, Xiaoyin 'Sara' Jiang

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    The American Thyroid Association (ATA) and American College of Radiology (ACR) TI-RADS systems show similar cancer prediction for thyroid nodules. However, ACR TI-RADS may miss malignancies in smaller TR3 and TR4 nodules.

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    Area of Science:

    • Radiology
    • Endocrinology
    • Oncology

    Background:

    • Thyroid nodule classification systems are crucial for predicting malignancy risk.
    • The American Thyroid Association (ATA) and American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) are widely used.
    • Comparing their diagnostic performance is essential for clinical decision-making.

    Purpose of the Study:

    • To compare the diagnostic performance of the ATA classification system and the ACR TI-RADS for predicting thyroid cancer.
    • To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both systems.
    • To assess the agreement between the two classification systems.

    Main Methods:

    • Retrospective review of ultrasound images of adult patients with thyroid nodules >5 mm who underwent thyroidectomy.
    • Assessment of malignancy prediction based on surgical histopathology.
    • Statistical comparison using McNemar's, Fisher exact, or DeLong's tests, including calculation of weighted Kappa statistic and area-under-the-curve (AUC).

    Main Results:

    • 323 nodules from 213 adults were analyzed; 27.2% were malignant.
    • Both systems demonstrated effective diagnostic performance with comparable sensitivity, specificity, PPV, and NPV.
    • High agreement was observed between ATA and ACR TI-RADS (weighted Kappa = 0.93).
    • Subanalysis revealed that 10% of TR3 (<2.5 cm) and 38% of TR4 (<1.5 cm) nodules were malignant, indicating a potential risk of missing malignancies with ACR TI-RADS.

    Conclusions:

    • The ATA and ACR TI-RADS classification systems exhibit similar diagnostic value in predicting thyroid cancer.
    • Consideration of size criteria in subanalysis of TR3 and TR4 nodules suggests a higher risk of missed malignancies when following ACR TI-RADS recommendations.
    • Further validation in diverse patient cohorts is recommended.