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ECR 2019 / C-0774
Certificate of Merit
Diagnostic accuracy of TIRADS in evaluation of thyroid nodules
Congress: ECR 2019
Poster No.: C-0774
Type: Scientific Exhibit
Keywords: Head and neck, Thyroid / Parathyroids, Ultrasound, Diagnostic procedure, Calcifications / Calculi, Cysts, Neoplasia
Authors: M. Mohandas, S. Nadarajan, N. Hubert, L. Jose; Thiruvananthapuram/IN
DOI:10.26044/ecr2019/C-0774

Aims and objectives

The widespread use of ultrasonography has contributed to increased detection of thyroid nodules. Nodular thyroid disease was classified by different guidelines and it was difficult to determine which nodule was suspicious of malignancy. 

 

TIRADS (Thyroid Imaging Reporting And Data System) is a reporting data system for thyroid lesions, proposed to standardize the reporting of results of thyroid ultrasound that can be understood by clinicians and also to stratify the risk of malignancy of a lesion based on ultrasound features. It was introduced by Horvath et al in 2009, drawing inspiration from “Breast Imaging and  Reporting Data System” (BIRADS) of the American College of Radiology and later simplified and modified by Park et al, Kim et al and Russ et al. Using the modified Russ classification, each nodule was classified into a TIRADS category (1, 2, 3, 4A, 4B and 5) based on the US features. 

 

The following categories of TIRADS were established by Russ et al:

TIRADS 1:Normal thyroid ultrasound

 

Fig. 1: Transverse sonogram showing normal thyroid gland - TIRADS 1
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

TIRADS 2:Benign aspects- Simple cyst, Spongiform nodule, White Knight aspect, Isolated macrocalcification and Typical subacute thyroiditis.

 

Fig. 2: Longitudinal sonogram of thyroid gland showing a simple cyst- TIRADS 2
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

TIRADS 3:Probably benign aspects- Isoechoic, Hyperechoic

 

Fig. 3: Transverse sonogram of thyroid showing a well defined isoechoic nodule - TIRADS 3
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

TIRADS 4A:Low Suspicious aspect- Moderately hypoechoic

 

Fig. 4: Transverse sonogram of thyroid showing a well defined moderately hypoechoic nodule - TIRADS 4A
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

TIRADS 4B&5:High Suspicious aspects- Taller than wide shape, Irregular/ microlobulated margins, Microcalcification, Marked hypoechogenecity.

 

TIRADS 4B: 1/2 signs and no adenopathy

 

Fig. 5: Longitudinal sonogram of thyroid showing a markedly hypoechoic nodule with microcalcification - TIRADS 4B
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

TIRADS 5: more than or equal to 3 signs and / or adenopathy

 

Fig. 6: Transverse sonogram of thyroid showing a taller than wide markedly hypoechoic nodule with microcalcification - TIRADS 5.
References: Dr. Somervell Memorial CSI Medical College - Thiruvananthapuram/IN

 

Risk of malignancy  

TIRADS 2: 0%, TIRADS 3: <5%, TIRADS 4A: 5‐10%, TIRADS 4B: 10‐80, TIRADS 5: >80%.

 

The purpose of this study is to determine the diagnostic test properties of Russ modified TIRADS in differentiating benign from malignant nodules taking cyto/histopathological diagnosis as gold standard. Secondly, to find out the proportion of malignancy in each TIRADS category.

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