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Updated: Dec 16, 2025
A Swin Transformer-Based Model for Thyroid Nodule Detection in Ultrasound Images
Published on: April 21, 2023
Diagnostic performances and unnecessary US-FNA rates of various TIRADS after application of equal size thresholds
Sun Huh1, Hye Sun Lee2, Jiyoung Yoon1
1Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
Insights
Modified thyroid nodule guidelines, particularly the mKwak, improve diagnostic accuracy and reduce unnecessary fine-needle aspirations (FNA). Applying the ACR TIRADS size threshold enhances performance across multiple thyroid imaging reporting and data systems (TIRADS) guidelines.
Area of Science:
- Radiology
- Oncology
- Diagnostic Imaging
Background:
- Thyroid nodule evaluation relies on various imaging guidelines.
- Optimizing these guidelines can improve diagnostic accuracy and reduce unnecessary procedures like fine-needle aspiration (FNA).
Purpose of the Study:
- To compare the diagnostic performance and unnecessary FNA rates of established and modified thyroid nodule imaging guidelines.
- To evaluate the impact of incorporating the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) size threshold into other TIRADS guidelines.
Main Methods:
- A retrospective study included 1,384 thyroid nodules from 1,301 patients with cytopathologic findings.
- Ultrasound (US) categories were assigned per guideline. ACR TIRADS size thresholds were applied to Kwak, ATA, and EU guidelines, creating modified versions (mKwak, mATA, mEU).
- Diagnostic performance metrics (specificity, accuracy, likelihood ratio (LR), area under the curve (AUC)) and unnecessary FNA rates were evaluated.
Main Results:
- The original ACR TIRADS showed the highest performance among initial guidelines (specificity 62.2%, accuracy 66%, LR 2.128, AUC 0.713).
- Modified guidelines (mKwak, mATA, mEU) demonstrated significantly improved specificity, accuracy, LR, and AUC compared to their original versions (P < 0.001).
- The mKwak guideline achieved the highest overall performance (specificity 64%, accuracy 68.6%, LR 2.389, AUC 0.75) with the lowest unnecessary FNA rate (61.1%).
Conclusions:
- Incorporating the ACR TIRADS size threshold into other TIRADS guidelines enhances diagnostic accuracy and reduces unnecessary FNAs.
- The modified Kwak (mKwak) guideline demonstrates superior diagnostic performance for thyroid nodules.
- These findings support the optimization of TIRADS guidelines for more efficient and accurate thyroid nodule management.
Abstract:
We compared the diagnostic performances and unnecessary FNA rates of several guidelines and modified versions using the size threshold of the ACR TIRADS. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent and all methods were performed in accordance with the Declaration of Helsinki. A total of 1,384 thyroid nodules in 1,301 patients with definitive cytopathologic findings were included. US categories were assigned according to each guideline. We applied the size threshold suggested by the ACR TIRADS for FNA to the Kwak, ATA and EU guidelines and defined these modified guidelines as the modified Kwak (mKwak), modified ATA (mATA) and modified EU (mEU) guidelines. Diagnostic performances and unnecessary FNA rates of all guidelines were evaluated. Of 1,384 thyroid nodules, 291 (21%) were malignant. Among the original guidelines, the ACR TIRADS had the highest specificity, accuracy, LR and AUC (62.2%, 66%, 2.128 and 0.713). The mKwak, mATA and mEU guidelines had higher specificity, accuracy, LR and AUC (P < 0.001 for all), and fewer unnecessary FNAs, compared with their original guidelines. Among all original and modified guidelines, the mKwak guideline had the highest specificity, accuracy, LR and AUC (64%, 68.6%, 2.389 and 0.75). The unnecessary FNA rate was the lowest with the mKwak guideline (61.1%). The highest sensitivity was observed with the ATA guideline (98.6%). After incorporating the size threshold of the ACR TIRADS to other TIRADS, all guidelines showed higher diagnostic accuracy and lower unnecessary FNA rates than their original versions. The mKwak guideline showed the best diagnostic performances.
