• Γεώργιος Σακοράφας

Thyroid nodule : TI-RADS classification based on ultrasonography


Introduction

Thyroid ultrasonography is currently the preferred imaging modality for the preoperative investigation of the patient with thyroid nodule. In order to improve consistency of reporting ultrasonographic findings, the TI-RADS system (Thyroid Imaging, Reporting and Data System) has been proposed by the American College of Radiology (ACR) in 2017.

The TI-RADS reporting system

The TI-RADS reporting system is based on 5 parameters-findings from diagnostic ultrasonography.

  1. Composition

  2. Echogenicity

  3. Shape (vertical vs. horizontal orientation)

  4. Margin and

  5. Echogenic foci

Interestingly, TI-RADS criteria do not encompass evaluation of regional lymph nodes.

Calculation of TI-RADS score

Sum points (designed for each of these characteristics) to calculate TI-RADS score, as follows:

TI-RADS 1

0 points

Benign lesion

No FNA

Cancer risk=0.3 %

TI-RADS 2

2 points

Not suspicious

No FNA

Cancer risk 1.5 %

TI-RADS 3

3 points

Mildly suspicious

1.5 cm: follow-up at 1, 3 and 5 yrs.

2.5 cm: FNA

Cancer risk 4.8 %

TI-RADS 4

4-6 points

Moderately suspicious

1 cm: follow up at 1,2,3 and 5 yrs. >1.5 cm: FNA

Cancer risk 9 %

TI-RADS 5

≥7

Highly suspicious

0.5 cm: follow-up annually for 5 yrs. > 1cm: FNA

Cancer risk 35 %

Practical usefulness of the TI-RADS system

The risk of underlying malignancy correlates with the TI-RADS category (see above).

The TI-RADS reporting system is useful in selecting optimal management of the patient with thyroid nodule: fine-needle aspiration cytology, follow-up ultrasonographic evaluation or no further action.

TI-RADS may reduce the number of thyroid nodules recommended for biopsy.


Thyroid nodule:TI-RADS classification based on ultrasonography

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