Do ACR TI-RADS scores demonstrate unique thyroid molecular profiles?

Area of Science:

• Endocrinology
• Molecular Diagnostics
• Radiology

Background:

• Cytologically indeterminate thyroid nodules require further evaluation.
• The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) stratifies nodules by ultrasound features.
• Molecular testing can refine risk stratification for indeterminate thyroid nodules.

Purpose of the Study:

• To investigate molecular profiles of indeterminate thyroid nodules based on TI-RADS categories.
• To determine if specific ultrasound features correlate with molecular alterations in thyroid nodules.

Main Methods:

• Retrospective review of 81 cases with indeterminate thyroid nodules (Bethesda System for Reporting Thyroid Cytopathology - TBSRTC categories).
• Nodules were assigned TI-RADS scores (TR1-TR5) based on ultrasound characteristics.
• Association between demographic factors, TI-RADS, TBSRTC diagnoses, and ThyroSeq molecular results was analyzed using logistic regression.

Main Results:

• RAS mutations were common across all TI-RADS categories.
• Aggressive mutations (BRAFV600E, TERT) were observed in higher TI-RADS categories (TR4 and TR5).
• ThyroSeq results correlated with malignancy when non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was included; echogenicity showed a negative correlation with molecular results.

Conclusions:

• Higher TI-RADS categories are associated with higher-risk molecular alterations in indeterminate thyroid nodules.
• Molecular profiling combined with TI-RADS may improve diagnostic accuracy for thyroid nodules.
• Ultrasound features, particularly echogenicity, may offer insights into underlying molecular characteristics.