Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Research Article Volume 3 Issue 3

Predicting Thyroid Nodule Malignancy Using TI-RADS and U-grading, a Retrospective Sonographical Analysis

Rishi Shukla1*, David Shatti2, John Cook2 and Andrew Carswell3

1Department of ENT Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, UK
2Department of Radiology, Great Western Hospital NHS Foundation Trust, UK
3Department of ENT Surgery, Royal United Hospitals Bath, UK

*Corresponding Author: Department of ENT Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, UK.

Received: December 01, 2020; Published: February 15, 2021



Introduction: British and American guidelines both utilise ultrasound (US) to determine the likeliness of a thyroid nodule being malignant based on a criteria of certain sonographic features. Is there a significant difference between grading systems in identifying malignant thyroid nodules?

Methods: A blinded retrospective cohort analysis of 115 thyroid US scans for adult male and female patients who underwent total or hemi thyroidectomy. BTA U and ACR TI-RAD scores were allocated and compared against final histology to assess for correlation. Two independent head and neck radiology physicians ensured inter-observer variability was reduced.

Results: The largest proportion of malignant lesions lie in the U2 category (13.9%) compared to U3 (8.69%) and for TI-RAD, malignant T2 lesions is 2.6%. Under the TI-RAD system a larger proportion of patients are sampled due to most U2 lesions being T3 categorised but malignant pickup is marginally higher at 11.3% vs 8.69% with a 20% increase in the number of patients needing to be sampled. Overall, patients were scored higher using TI-RAD.

Conclusions: When comparing the TI-RAD against the U-grading system, the latter has greater specificity, PPV and NPV. Limitations are U2/T2 (benign) and U3/T3 (indeterminate) graded lesions. TI-RAD grading is radiologically more cautious; therefore, more lesions are sampled for a modest increase in detection. Both systems have positive and negative attributes but the financial and patient morbidity associated with excess investigation the TI-RAD system does not offer a greater pickup rate based on risk but rather volume. Given the current financial burden on the NHS, is implementation of a system which increases clinical and investigation time for an 11% increase in cancer pickup rate beneficial? The rationale behind such a comment is that radiological identification of disease identified varies and one must also consider the importance of false positives and incidentalomas.

Keywords: Thyroid Nodule; Thyroid Cancer; Ultrasound; Risk; Standards



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Citation: Rishi Shukla., et al. “Predicting Thyroid Nodule Malignancy Using TI-RADS and U-grading, a Retrospective Sonographical Analysis". Acta Scientific Otolaryngology 3.3 (2021): 16-19.


Acceptance rate34%
Acceptance to publication20-30 days
Impact Factor0.871

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