Comparison of Thyroid Risk Categorization Systems and Fine-Needle Aspiration Recommendations in a Multi-Institutional...

Area of Science:

• Endocrinology
• Radiology
• Oncology

Background:

• Thyroid nodules are common, and distinguishing benign from malignant requires accurate risk stratification.
• Various imaging reporting and data systems exist to guide fine-needle aspiration (FNA) decisions for thyroid nodules.
• Comparing these systems is crucial for optimizing diagnostic accuracy and patient management.

Purpose of the Study:

• To compare the FNA recommendation rates for thyroid nodules across five different reporting systems: ACR TI-RADS, ATA guidelines, K-TIRADS, EU-TIRADS, and AI-TIRADS.
• To evaluate how these systems impact biopsy decisions in a low-risk adult patient population.

Main Methods:

• A prospective collection of thyroid ultrasound reports from seven practices was analyzed.
• Nodule characteristics were recorded using a structured template.
• Nodules were retrospectively categorized using the criteria of ACR TI-RADS, ATA, K-TIRADS, EU-TIRADS, and AI-TIRADS to compare FNA recommendation rates.

Main Results:

• ACR TI-RADS recommended FNA for 29.1% of nodules, significantly lower than ATA (58.7%), K-TIRADS (57.0%), and EU-TIRADS (38.9%). AI-TIRADS recommended FNA for 26.3%.
• ACR TI-RADS showed the lowest FNA recommendation rates for TR3 (18%) and TR4 (30%) nodules.
• At high suspicion levels, FNA rates were similar across all systems (68.7%–75.5%).

Conclusions:

• ACR TI-RADS recommends 25% to 50% fewer biopsies than ATA, EU-TIRADS, and K-TIRADS.
• Differences in size thresholds and risk stratification criteria contribute to the lower biopsy recommendations by ACR TI-RADS.
• ACR TI-RADS categorizes more nodules as TR2, which do not require FNA, potentially reducing unnecessary procedures.