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Related Concept Videos

The Thyroid Gland01:23

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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From Guidelines to Intelligence: How AI Refines Thyroid Nodule Biopsy Decisions.

Weibo Zeng1, Yanni He2, Renhao Xu2

  • 1The Second School of Clinical Medicine, Southern Medical University, Guangzhou, P.R. China; Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.

Ultrasound in Medicine & Biology
|June 1, 2025
PubMed
Summary

Combining the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) with the Demetics system significantly reduces unnecessary thyroid nodule biopsies and missed diagnoses, improving diagnostic accuracy.

Keywords:
ACR TI-RADSArtificial intelligenceThe biopsy rateThyroid nodules

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Area of Science:

  • Radiology
  • Medical Diagnostics
  • Ultrasound Imaging

Background:

  • Thyroid nodules require accurate risk stratification for appropriate management.
  • The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is a standard tool for classifying thyroid nodules.
  • Fine-needle aspiration (FNA) biopsy is often used but can lead to unnecessary procedures and missed diagnoses.

Purpose of the Study:

  • To evaluate the effectiveness of combining the ACR TI-RADS with the Demetics ultrasound diagnostic system.
  • To assess the impact of this combined system on reducing fine-needle aspiration (FNA) biopsy rates for thyroid nodules.
  • To compare the diagnostic performance, including unnecessary biopsy and missed diagnosis rates, of the ACR TI-RADS alone versus the combined system.

Main Methods:

  • A retrospective analysis of 548 thyroid nodules from 454 patients meeting ACR TI-RADS guidelines (category ≥3, diameter ≥10 mm) was conducted.
  • Nodules were initially classified using ACR TI-RADS alone.
  • Nodules were then reclassified using the combined ACR TI-RADS and Demetics system (De TI-RADS) for comparison.

Main Results:

  • The ACR TI-RADS alone resulted in a 70.6% biopsy rate with a 47.5% unnecessary biopsy rate and an 11.0% missed diagnosis rate.
  • The combined De TI-RADS approach reduced the biopsy rate to 48.1% and the unnecessary biopsy rate to 17.4%.
  • The combined system also decreased the missed diagnosis rate to 4.4% and increased the positive predictive value (PPV) to 82.6%, with all changes being statistically significant (p < 0.05).

Conclusions:

  • The integration of ACR TI-RADS with the Demetics system significantly enhances thyroid nodule risk assessment.
  • This combined approach improves diagnostic accuracy and efficiency, leading to fewer unnecessary biopsies and reduced missed diagnoses.
  • The De TI-RADS offers a more reliable tool for clinicians, improving patient care and outcomes.