Ultrasound Risk Stratification of Thyroid Nodules: Comparative Accuracy of TIRADS in Predicting Malignancy

Objective: To evaluate the diagnostic performance of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the American Thyroid Association (ATA) ultrasound risk stratification systems in predicting malignancy in thyroid nodules. Methods: A prospective analysis was conducted on 250 patients who underwent thyroid ultrasound and subsequent fine-needle aspiration (FNA) or surgery between 2023 and 2024. Each nodule was categorized using both ACR TI-RADS and ATA systems. Histopathological results served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both systems. Results: Of the 250 nodules, 50 (20%) were malignant. The ACR TI-RADS system demonstrated a sensitivity of 52%, specificity of 90%, PPV of 82.5%, NPV of 67.2%, and an overall accuracy of 71.7%. The ATA system showed a sensitivity of 52%, specificity of 80%, PPV of 70%, NPV of 65%, and an overall accuracy of 67%. Conclusion: Both ACR TI-RADS and ATA systems are valuable tools for risk stratification of thyroid nodules. ACR TI-RADS exhibited higher specificity and overall accuracy in this cohort, suggesting its potential superiority in clinical decision-making.