Use of an Easily Applicable Thyroid Imaging-Reporting and Data System (TI-RADS): Our Kwak TI-RADS Experience

Early detection of malignant thyroid nodules is possible using ultrasonography (US)-guided fine needle aspiration biopsy (US-FNAB), which is a minimally invasive and easily applicable method. There are several guidelines based on the US findings, including the Thyroid Imaging-Reporting and Data System (TI-RADS), to identify patients requiring FNAB or patients with nodules suspicious of malignancy.

To emphasize the importance of the easily applicable Kwak TI-RADS classification system.

In this cross-sectional study, the radiological and pathological findings of 641 consecutive patients, who underwent US-FNAB in our center, were retrospectively evaluated. The relationship between the cytological/histopathological results and the US findings was investigated using univariate and multivariate analyses. The results were also compared with the data in the literature.

In the univariate analysis, US features, including the presence of a solid component, hypoechogenicity, microlobulation or irregular margins, microcalcifications, and a taller-than-wide shape, were significantly associated with malignancy (P < 0.05). However, in the multivariate analysis, only hypoechogenicity and a taller-than-wide shape significantly contributed to the diagnosis of malignancy (P < 0.05). The malignancy rates of TI-RADS 3, 4a, and 4b lesions were lower in the present study compared to the literature.

The US features, including the presence of a solid component, microcalcifications, hypoechogenicity, microlobulation or irregular margins, and a taller-than-wide shape, must be evaluated during US examinations. Besides, the widespread use of Kwak TI-RADS classification system, similar to the Breast Imaging-Reporting and Data System (BI-RADS), should be encouraged to provide a common tool for clinicians and prevent unnecessary surgical procedures.