New Thyroid Imaging Reporting and Data System (TIRADS) Based on Ultrasonography Features for Follicular Thyroid...

Area of Science:

• Endocrinology
• Radiology
• Oncology

Background:

• Preoperative diagnosis of follicular thyroid neoplasm (FTN) is challenging.
• Current ultrasound risk stratification systems (RSSs) are not optimal for FTN, leading to potential misdiagnoses and unnecessary biopsies.

Purpose of the Study:

• To develop and validate a novel RSS, FTN-TIRADS, for improved preoperative evaluation of FTN.
• To reduce missed diagnoses and unnecessary fine needle aspirations (FNA) for follicular thyroid nodules.

Main Methods:

• A retrospective study of 535 FTNs from four hospitals.
• Development of FTN-TIRADS based on ultrasound features using univariate and logistic regression analysis.
• Comparison of FTN-TIRADS diagnostic performance against EU-RSS, ATA-RSS, ACR-TIRADS, and C-TIRADS using receiver operating characteristic curve analysis and AUC.
• Calculation and comparison of unnecessary FNA rates.

Main Results:

• FTN-TIRADS demonstrated a higher AUC (0.855) compared to existing RSSs (EU-RSS: 0.759, ATA-RSS: 0.759, ACR-TIRADS: 0.753, C-TIRADS: 0.677).
• The FTN-TIRADS showed comparable diagnostic performance in validation and test groups (AUC 0.879 vs. 0.855).
• FTN-TIRADS significantly reduced the unnecessary FNA rate to 41.4% compared to other systems (ranging from 60.1% to 69.0%).

Conclusions:

• FTN-TIRADS provides superior differential diagnosis for FTN compared to current RSSs.
• This new system effectively lowers the rate of unnecessary FNA, potentially reducing unnecessary surgeries.
• FTN-TIRADS serves as a reliable preoperative, noninvasive tool for assessing thyroid follicular tumors.