Using TR5 as a rule-in test was similar to random selection (specificity 89% vs 90%). These publications erroneously add weight to the belief that TIRADS is a proven and superior model for the investigation of thyroid nodules. NCI Thyroid FNA State of the Science Conference, The Bethesda System for reporting thyroid cytopathology, ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee, Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size, Impact of nodule size on malignancy risk differs according to the ultrasonography pattern of thyroid nodules, TIRADS management guidelines in the investigation of thyroid nodules; an illustration of the concerns, costs and performance, Thyroid nodules with minimal cystic changes have a low risk of malignancy, [The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid], Malignancy risk stratification of thyroid nodules: comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines, Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination, Machine learning-assisted system for thyroid nodule diagnosis, Automatic thyroid nodule recognition and diagnosis in ultrasound imaging with the YOLOv2 neural network, Using artificial intelligence to revise ACR TI-RADS risk stratification of thyroid nodules: diagnostic accuracy and utility, A multicentre validation study for the EU-TIRADS using histological diagnosis as a gold standard, Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules, Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules, Diagnostic performance of practice guidelines for thyroid nodules: thyroid nodule size versus biopsy rates, Comparison of performance characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association Guidelines, Performance of five ultrasound risk stratification systems in selecting thyroid nodules for FNA. Shin JH, Baek JH, Chung J, et al. See this image and copyright information in PMC. A 35-year-old woman with a nodule in the left-lobe of her thyroid gland. Instead, it has been applied on retrospective data sets, with cancer rates far above 5%, rather than on consecutive unselected patients presenting with a thyroid nodule [33]. In a cost-conscious public health system, one could argue that after selecting out those patients that clearly raise concern for a high risk of cancer (ie, from history including risk factors, examination, existing imaging) the clinician could reasonably inform an asymptomatic patient that they have a 95% chance of their nodule being benign. ACR TI-RADS FAQ : RADS - Reporting and Data Systems Support Data Set Used for Development of ACR TIRADS [16] and Used for This Paper The possible cancer rate column is a crude, unvalidated estimate, calculated by proportionately reducing the cancer rates by 10.3%: 5% to reflect the likely difference in the cancer rate in the data set used (10.3%) and in the population presenting with a thyroid nodule (5%). eCollection 2022. TI-RADS 4c applies to the lesion with three to five of the above signs and/or a metastatic lymph node is present. Haugen BR, Alexander EK, Bible KC, et al. Following ACR TIRADS management guidelines would likely result in approximately one-half of the TR3 and TR4 patients getting FNAs ((0.537)+(0.323)=25, of total 60), finding up to 1 cancer, and result in 4 diagnostic hemithyroidectomies for benign nodules (250.20.8=4). This assumption is obviously not valid and favors TIRADS management guidelines, but we believe it is helpful for clarity and illustrative purposes. PMC The system has fair interobserver agreement 4. But the test that really lets you see a nodule up close is a CT scan. doi: 10.12659/MSM.936368. Second, we then apply TIRADS across all 5 nodule categories to give an idea how TIRADS is likely to perform overall. TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance J Endocr Soc. Approach to Bethesda system category III thyroid nodules - PubMed We found sensitivity and PPV with TIRADS was poor, but was better than random selection (sensitivity 53% vs 1%, and PPV 34% vs 1%) whereas specificity, NPV, and accuracy was no better with TIRADS compared with random selection (specificity 89% vs 90%, NPV 94% vs 95%, and accuracy 85% vs 85%), Table 2 [25]. If the nodule got a score of 2 in the CEUS schedule, the CEUS-TIRADS category remained the same as before. Cao H, Fan Q, Zhuo S, Qi T, Sun H, Rong X, Xiao X, Zhang W, Zhu L, Wang L. J Ultrasound Med. 3, 4 The modified TI-RADS based on the ACR TI-RADS scoring system was sponsored by Wang et al. You can then get a more thorough medical evaluation, including a biopsy, which is a small sample of tissue from the nodule to look at under the microscope. Haymart MR, Banerjee M, Reyes-Gastelum D, Caoili E, Norton EC. J. Endocrinol. doi: 10.1111/j.1754-9485.2009.02060.x However, in the data set, only 25% of all nodules were categorized as TR1 or TR2 and these nodules harbored only 1% of all thyroid cancers (9 of 343). 4. A normal finding in Finland. Thyroid imaging reporting and data system (TI-RADS). As noted previously, we intentionally chose the clinical comparator to be relatively poor and not a fair reflection of real-world practice, to make it clearer to what degree ACR TIRADS adds value. Diagnosis and Management of Small Thyroid Nodules: A Comparative Study with Six Guidelines for Thyroid Nodules. TI-RADS 4b applies to the lesion with one or two of the above signs and no metastatic lymph node is present. Most nodules and swellings are not cancerous. Whereas using TIRADS as a rule-in cancer test would be the finding that a nodule is TR5, with a sufficiently high chance of cancer that further investigations are required, compared with being TR1-4. Furuya-Kanamori L, Bell KJL, Clark J, Glasziou P, Doi SAR. TR5 in the data set made up 16% of nodules, in which one-half of the thyroid cancers (183/343) were found. To establish a CEUS-TIRADS diagnostic model to differentiate thyroid nodules (C-TIRADS 4) by combining CEUS with Chinese thyroid imaging reporting and data system (C-TIRADS). Radiology. The authors stated that TI-RADS 4 and 5 nodules must be biopsied. The area under the curve was 0.803. to propose a simpler TI-RADS in 2011 2. However, the consequent management guidelines are difficult to justify at least on a cost basis for a rule-out test, though ACR TIRADS may provide more value as a rule-in test for a group of patients with higher cancer risk. A robust validation study is required before the performance and cost-benefit outcomes of any of the TIRADS systems can be known. The gender bias (92% female) and cancer prevalence (10%) of the data set suggests it may not accurately reflect the intended test population. Clinical Application of C-TIRADS Category and Contrast-Enhanced Ultrasound in Differential Diagnosis of Solid Thyroid Nodules Measuring 1 cm. The gold test standard would need to be applied for comparison. The consequences of these proportions are highly impactful when considering the real-world performance of ACR-TIRADS. In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. Thyroid Nodules: When to Worry | Johns Hopkins Medicine Reference article, Radiopaedia.org (Accessed on 05 Mar 2023) https://doi.org/10.53347/rID-21448. The probability of malignancy was based on an equation derived from 12 features 2. Federal government websites often end in .gov or .mil. They are found . Alternatively, if random FNAs are performed in 1 in 10 nodules, then 4.5 thyroid cancers (4-5 people per 100) will be missed. Thyroid Cancer: Diagnosis, Treatment and Follow-Up | IntechOpen The following article describes the initial iterations proposed by individual research groups, none of which gained widespread use. The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS. These cutoffs are somewhat arbitrary, with conflicting data as to what degree, if any, size is a discriminatory factor. The diagnostic performance of CEUS-TIRADS was significantly better than CEUS and C-TIRADS. This paper has only examined the ACR TIRADS system, noting that other similar systems exist such as Korean TIRADS [14]and EU TIRADS [15]. tirads 4 thyroid nodule treatment - yaeyamasyoten.com If one assumes that they do, then it is important to note that 25% of patients make up TR1 and TR2 and only 16% of patients make up TR5. This is likely an underestimate of the number of scans needed, given that not all nodules that are TR1 or TR2 will have purely TR1 or TR2 nodules on their scan. Radiology. Furthermore, we are presuming other clinical factors (ie, palpability, size, number, symptoms, age, gender, prior radiation exposure, family history) add no diagnostic value above random selection. There are a number of additional issues that should be taken into account when examining the ACR TIRADS data set and resultant management recommendations. The site is secure. Thus, the absolute risk of missing important cancer goes from 4.5% to 2.5%, so NNS=100/2=50. The difference was statistically significant (P<0.05). Quite where the cutoff should be is debatable, but any cutoff below TR5 will have diminishing returns and increasing harms. What percentage of TR4 nodules are cancerous? - TimesMojo Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, Kim SH. 4. EU-TIRADS 2 category comprises benign nodules with a risk of malignancy close to 0%, presented on sonography as pure/anechoic cysts ( Figure 1A) or entirely spongiform nodules ( Figure 1B ). Therefore, for every 25 patients scanned (100/4=25) and found to be either TR1 or TR2, 1 additional person would be correctly reassured that they do not have thyroid cancer. If one accepts that the pretest probability of a patient presenting with a thyroid nodule having an important thyroid cancer is 5%, then clinicians who tell every patient they see that they do not have important thyroid cancer will be correct 95% of the time. Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Such validation data sets need to be unbiased. A total of 228 thyroid nodules (C-TIRADS 4) were estimated by CEUS. FNA, fine-needle aspiration; US, ultrasound; CEUS, contrast-enhanced, A 38-year-old woman with a nodule in the right-lobe of her thyroid gland., A 35-year-old woman with a nodule in the left-lobe of her thyroid gland., The ROC curves of C-TIRADS, CEUS, and CEUS-TIRADS of 228 nodules in the. 2018;287(1):29-36. The pathological result was papillary thyroid carcinoma. Update of the Literature. The ACR-TIRADS guidelines also provide easy-to-follow management recommendations that have understandably generated momentum. The summary of test performance of random selection, ACR TIRADS as a rule-out test, ACR TIRADS as a rule-in test, and ACR TIRADS applied across all TIRADS categories are detailed in Table 2, and the full data, definitions, and calculations are given elsewhere [25]. The ROC curves of C-TIRADS, CEUS, and CEUS-TIRADS of 100 nodules in the. K-TIRADS category was assigned to the thyroid nodules. For this, we do take into account the nodule size cutoffs but note that for the TR3 and TR4 categories, ACR TIRADS does not detail how it chose the size cutoffs of 2.5 cm and 1.5 cm, respectively. Please enable it to take advantage of the complete set of features! 2021 Dec 7;101(45):3748-3753. doi: 10.3760/cma.j.cn112137-20210401-00799. Advances in knowledge: The study suggests TIRADS and thyroid nodule size as sensitive predictors of malignancy. This study aimed to assess the performance and costs of the American College of Radiology (ACR) Thyroid Image Reporting And Data System (TIRADS), by first looking for any important issues in the methodology of its development, and then illustrating the performance of TIRADS for the initial decision for or against FNA, compared with an imagined This equates to 2-3 cancers if one assumes a thyroid cancer prevalence of 5% in the real world. Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System Front Oncol. Among thyroid nodules detected during life, the often quoted figure for malignancy prevalence is 5% [5-8], with UptoDate quoting 4% to 6.5% in nonsurgical series [9], and it is likely that only a proportion of these cancers will be clinically significant (ie, go on to cause ill-health). 1 Most thyroid nodules are detected incidentally when imaging is performed for another indication. To develop a medical test a typical process is to generate a hypothesis from which a prototype is produced. PLoS ONE. TI-RADS 1: Normal thyroid gland. However, most of the sensitivity benefit is due to the performance in the TR1 and TR2 categories, with sensitivity in just the TR3 and TR4 categories being only 46% to 62%, depending on whether the size cutoffs add value (data not shown). That particular test is covered by insurance and is relatively cheap. The diagnosis or exclusion of thyroid cancer is hugely challenging. This is a specialist doctor who specializes in the treatment and diagnosis of thyroid cancer. The first time Tirads 3 after cytology is benign, but you do not say how many mm and after 3 months of re-examination, it was . A study that looked at all nodules in consecutive patients (eg, perhaps FNA of every nodule>10 mm) would be required to get an accurate measure of the cancer prevalence in those nodules that might not typically get FNA. Russ G, Royer B, Bigorgne C et-al. 2020 Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules: The. Perhaps surprisingly, the performance ACR-TIRADS may often be no better than random selection. If a guideline indicates that FNA is recommended, it can be difficult to oppose this based on other factors. Im on a treatment plan with my oncologist, my doctor, and Im about to start my next round of treatments. We have detailed the data set used for the development of ACR TIRADS [16] in Table 1, plus noted the likely cancer rates in the real world if one assumes that the data set cancer prevalence (10.3%) is double that in the population upon which the test is intended to be used (pretest probability of 5%). Unfortunately, the collective enthusiasm for welcoming something that appears to provide certainty has perhaps led to important flaws in the development of the models being overlooked. 3. Refer to separate articles for the latest systems supported by various professional societies: A TI-RADS was first proposed by Horvath et al. This data set was a subset of data obtained for a previous study and there are no clear details of the inclusion and exclusion criteria, including criteria for FNA. Yoon JH, Han K, Kim EK, Moon HJ, Kwak JY. (2017) Radiology. 2013;168 (5): 649-55. However, if the concern is that this might miss too many thyroid cancers, then this could be compared with the range of alternatives (ie, doing no tests or doing many more FNAs). J Adolesc Young Adult Oncol (2020) 9(2):2868. Check for errors and try again. The more carefully one looks for incidental asymptomatic thyroid cancers at autopsy, the more are found [4], but these do not cause unwellness during life and so there is likely to be no health benefit in diagnosing them antemortem. TIRADS 6: category included biopsy proven malignant nodules. Other limitations include the various assumptions we have made and that we applied ACR TIRADS to the same data set upon which is was developed. Once the test is considered to be performing adequately, then it would be tested on a validation data set. The costs depend on the threshold for doing FNA. The figures that TIRADS provide, such as cancer prevalence in certain groups of patients, or consequent management guidelines, only apply to populations that are similar to their data set. The Thyroid Imaging Reporting And Data System (TI-RADS) was developed by the American College of Radiology and used by many radiologist in Australia. Keywords: Conclusions: The findings that ACR TIRADS has methodological concerns, is not yet truly validated, often performs no better than random selection, and drives significant costs and potential harm, are very unsettling but result from a rational and scientific assessment of the foundational basis of the ACR TIRADS system. 4b - Suspicious nodules (10-50% risk of malignancy) Score of 2. The flow chart of the study. The main source data set for the ACR TIRADS recommendations was large and consisted of US images and FNA results of more than 3400 nodules [16]. These patients are not further considered in the ACR TIRADS guidelines. This allows patients with a TR1 or TR2 nodule to be reassured that they have a low risk of thyroid cancer, rather than a mixture of nodules (not just TR1 or TR2) not being able to be reassured. If you do 100 (or more) US scans on patients with a thyroid nodule and apply the ACR TIRADS management guidelines for FNA, this results in costs and morbidity from the resultant FNAs and the indeterminate results that are then considered for diagnostic hemithyroidectomy. Unauthorized use of these marks is strictly prohibited. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. 8600 Rockville Pike We first estimate the performance of ACR TIRADS guidelines recommended approach to the initial decision to perform FNA, by using TR1 or TR2 as a rule-out test, or using TR5 as a rule-in test because applying TIRADS at the extremes of pretest cancer risk (TR1 and TR2 for lowest risk, and TR5 for highest risk), is most likely to perform best. The performance of any diagnostic test in this group has to be truly exceptional to outperform random selection and accurately rule in or rule out thyroid cancer in the TR3 or TR4 groups. Among the 228 C-TIRADS 4 nodules, 69 were determined as C-TIRADS 4a, 114 were C-TIRADS 4b, and 45 were C-TIRADS 4c. doi: 10.3390/diagnostics11081374 The ACR TIRADS management flowchart also does not take into account these clinical factors. For example, a previous meta-analysis of more than 25,000 FNAs showed 33% were in these groups [17]. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. TI-RADS 2: Benign nodules. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. 2022 Jan 6;2022:5623919. doi: 10.1155/2022/5623919. The proportion of malignancy in Bethesda III nodules confirmed by surgery were significantly increased in proportion relative to K-TIRADS with 60.0% low suspicion, 88.2% intermediate suspicion, and 100% high suspicion nodules (p < 0.001). Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. Thyroid Nodules - Diagnosis, Treatment, & More - YouTube What does a hypoechoic thyroid nodule mean? - Medical News Today The frequency of different Bethesda categories in each size range . Endocrine (2020) 70(2):25679. Zhonghua Yi Xue Za Zhi. Authors Tiantong Zhu 1 , Jiahui Chen 1 , Zimo Zhou 2 , Xiaofen Ma 1 , Ying Huang 1 Affiliations ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Those wishing to continue down the investigative route could then have US, using TIRADS or ATA guidelines or other measures to offer some relative risk-stratification. They will want to know what to do with your nodule and what tests to take. Eur. official website and that any information you provide is encrypted Kwak JY, Han KH, Yoon JH et-al. doi: 10.1016/S0140-6736(14)62242-X In 2017, the Thyroid Imaging Reporting and Data System (TI-RADS) Committee of the American College of Radiology (ACR) published a white paper that presented a new risk-stratification system for classifying thyroid nodules on the basis of their appearance at ultrasonography (US). TIRADS 5: probably malignant nodules (malignancy >80%). In: Thyroid 26.1 (2016), pp. Thyroid Tirads 4: Thyroid lesions with suspicious signs of malignancy. Anti-thyroid medications. This site needs JavaScript to work properly. The. Tirads 5 thyroid gland: is a thyroid gland with 5 or more lesions, the rate of malignancy accounts for 87.5%. Second, the proportion of patients in the different ACR TIRADS (TR) categories may, or may not, reflect the real-world population (Table 1). A minority of these nodules are cancers. sharing sensitive information, make sure youre on a federal 'Returning to TI-RADS' may assist with triage of indeterminate thyroid 2022 Jun 30;12:840819. doi: 10.3389/fonc.2022.840819. Each variable is valued at 1 for the presence of the following and 0 otherwise: The above systems were difficult to apply clinically due to their complexity, leading Kwak et al. Thyroid Nodules. Only a small percentage of thyroid nodules are cancerous. Many studies have not found a clear size/malignancy correlation, and where it has been found, the magnitude of the effect is modest. Attempts to compare the different TIRADS systems on data sets that are also not reflective of the intended test population are similarly flawed (eg, malignancy rates of 41% [29]). Careers. Now, the first step in T3N treatment is usually a blood test. FOIA Copyright 2022 Zhu, Chen, Zhou, Ma and Huang. Given that a proportion of thyroid cancers are clinically inconsequential, the challenge is finding a test that can effectively rule-in or rule-out important thyroid cancer (ie, those cancers that will go on to cause morbidity or mortality). Thyroid nodules are a common finding, especially in iodine-deficient regions. Tessler FN, Middleton WD, Grant EG, et al. These figures cannot be known for any population until a real-world validation study has been performed on that population. The other one-half of the cancers that are missed by only doing FNA of TR5 nodules will mainly be in the TR3 and TR4 groups (that make up 60% of the population), and these groups will have a 3% to 8% chance of cancer, depending upon whether the population prevalence of thyroid cancer in those being tested is 5% or 10%. ; Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. The system is sometimes referred to as TI-RADS French 6. Bookshelf Many of these papers share the same fundamental problem of not applying the test prospectively to the population upon which it is intended for use. The equation was as follows: z = -2.862 + 0.581X1- 0.481X2- 1.435X3+ 1.178X4+ 1.405X5+ 0.700X6+ 0.460X7+ 0.648X8- 1.715X9+ 0.463X10+ 1.964X11+ 1.739X12. With the right blood tests, you can see if you have a thyroid nodule, and if so, you can treat it with radioactive iodine. spiker54. -, Zhou J, Yin L, Wei X, Zhang S, Song Y, Luo B, et al. Castellana M, Castellana C, Treglia G, Giorgino F, Giovanella L, Russ G, Trimboli P. Oxford University Press is a department of the University of Oxford. Objective: To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Clipboard, Search History, and several other advanced features are temporarily unavailable. There are inherent problems with studies addressing the issue such as selection bias at referral centers and not all nodules having fine needle aspiration (FNA). Objectives: There are two suspicious signs with the nodule (solid and irregular margin) and it was defined as C-TIRADS 4b. 24;8 (10): e77927. Jin Z, Zhu Y, Lei Y, Yu X, Jiang N, Gao Y, Cao J. Med Sci Monit. 5 The modified TI-RADS was composed of seven ultrasound features in identifying benign and malignant thyroid nodules, such as the nodular texture, nodular This causes the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months. Write for us: What are investigative articles. Frontiers | Differentiation of Thyroid Nodules (C-TIRADS 4) by Full data including 95% confidence intervals are given elsewhere [25]. It should also be on an intention-to-test basis and include the outcome for all those with indeterminate FNAs. We assessed a hypothetical clinical comparator where 1 in 10 nodules are randomly selected for fine needle aspiration (FNA), assuming a pretest probability of clinically important thyroid cancer of 5%. It is limited by only being an illustrative example that does not take clinical factors into account such as prior radiation exposure and clinical features. National Library of Medicine Tessler F, Middleton W, Grant E. Thyroid Imaging Reporting and Data System (TI-RADS): A Users Guide. The detection rate of thyroid cancer has increased steeply with widespread utilization of ultrasound (US) and frequent incidental detection of thyroid nodules with other imaging modalities such as computed tomography, magnetic resonance imaging, and, more recently, positron emission tomography-computed tomography, yet the mortality from thyroid cancer has remained static [10, 11]. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Treatment of patients with the left lobe of the thyroid gland, tirads 3 The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer A recent meta-analysis comparing different risk stratification systems included 13,000 nodules, mainly from retrospective studies, had a prevalence of cancer of 29%, and even in that setting the test performance of TIRADS was disappointing (eg, sensitivity 74%, specificity 64%, PPV 43%, NPV 84%), and similar to our estimated values of TIRADS test performance [38]. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Thyroid Nodules: Causes, Symptoms & Treatment - Cleveland Clinic Department of Endocrinology, Christchurch Hospital. J Med Imaging Radiat Oncol (2009) 53(2):17787. The optimal investigation and management of the 84% of the population harboring the remaining 50% of cancer remains unresolved. The management guidelines may be difficult to justify from a cost/benefit perspective. Mao S, Zhao LP, Li XH, Sun YF, Su H, Zhang Y, Li KL, Fan DC, Zhang MY, Sun ZG, Wang SC. Thyroid nodules are detected by ultrasonography in up to 68% of healthy patients. Cheng H, Zhuo SS, Rong X, Qi TY, Sun HG, Xiao X, Zhang W, Cao HY, Zhu LH, Wang L. Int J Endocrinol. Would you like email updates of new search results? Thyroid imaging reporting and data system (TI-RADS) Any additional test has to perform exceptionally well to surpass this clinicians 95% negative predictive performance, without generating false positive results and consequential harm. Data Availability: All data generated or analyzed during this study are included in this published article or in the data repositories listed in References. Given the need to do more than 100 US scans to find 25 patients with just TR1 or TR2 nodules, this would result in at least 50 FNAs being done. Other similar systems are in use internationally (eg, Korean-TIRADS [14] and EU-TIRADS [15]).
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