Cancer risk estimation using American College of Radiology Thyroid Imaging Reporting and Data System for cytologically indeterminate thyroid nodules


      • Combining TI-RADS score with Bethesda diagnostic grouping allows for more accurate preoperative thyroid nodule ROM estimation.
      • TI-RADS score of 5 increases the ROM estimation for thyroid nodules with any Bethesda diagnosis.
      • For Bethesda diagnostic groupings less than VI, the TI-RADS score was more predictive of ROM.



      We sought to determine if using the ACR TI-RADS ultrasound score combined with the Bethesda diagnosis can help augment thyroid cancer risk estimation.


      TI-RADS scores and Bethesda diagnoses were collected for patients treated in our center who had undergone thyroidectomy. Data from 186 patients with both TI-RADS scores and Bethesda diagnosis, and Bethesda diagnosis alone, were analyzed by multivariable regression analysis and observed for whether the pathology was benign or malignant.


      The regression analysis model showed that as the TI-RADS score increases, the odds of malignancy increases as well. The predictive value of the odds of malignancy in a thyroid nodule using both Bethesda diagnosis and TI-RADS score together was more powerful than the odds given using the Bethesda diagnosis alone.


      Our model shows that the ACR TI-RADS score may assist with preoperative decision-making for patients with cytologically indeterminate thyroid nodules when combined with Bethesda diagnosis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Durante C.
        • Grani G.
        • Lamartina L.
        • Filetti S.
        • Mandel S.J.
        • Cooper D.S.
        The diagnosis and management of thyroid nodules a review.
        JAMA, J Am Med Assoc. 2018;
        • Singer P.A.
        • Cooper D.S.
        • Daniels G.H.
        • et al.
        Treatment guidelines for patients with thyroid nodules and well- differentiated thyroid cancer.
        Arch Intern Med. 1996;
        • Yousem D.M.
        • Huang T.
        • Loevner L.A.
        • Langlotz C.P.
        Clinical and Economic Impact of Incidental Thyroid Lesions Found with CT and MR.
        American Journal of Neuroradiology., 1997
        • Nguyen X.V.
        • Choudhury K.R.
        • Eastwood J.D.
        • et al.
        Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules.
        AJNR Am J Neuroradiol. 2013; 34: 1812-1817
        • Guth S.
        • Theune U.
        • Aberle J.
        • Galach A.
        • Bamberger C.M.
        Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.
        Eur J Clin Invest. 2009;
        • Haugen B.R.
        • Alexander E.K.
        • Bible K.C.
        • et al.
        American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2015; 26 (2016): 1-133
        • Cibas E.S.
        • Ali S.Z.
        The Bethesda system for reporting thyroid cytopathology.
        Am J Clin Pathol. 2009;
        • Maia F.F.R.
        • Matos P.S.
        • Pavin E.J.
        • Zantut-Wittmann D.E.
        Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology.
        Clin Endocrinol. 2015;
        • Grani G.
        • Lamartina L.
        • Ascoli V.
        • et al.
        Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules.
        Endocrine. 2017;
        • Barbosa T.L.M.
        • Junior C.O.M.
        • Graf H.
        • et al.
        ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology.
        BMC Endocr Disord. 2019;
        • Horvath E.
        • Majlis S.
        • Rossi R.
        • et al.
        An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management.
        J Clin Endocrinol Metab. 2009;
        • Tessler F.N.
        • Middleton W.D.
        • Grant E.G.
        • et al.
        ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee.
        J Am Coll Radiol. 2017;
        • Oosthuizen J.L.
        • Walker B.
        • Todorovic E.
        • Masoudi H.
        • Wiseman S.M.
        The presence of papillary features in thyroid nodules diagnosed as atypia of undetermined significance or follicular lesion of undetermined significance increases cancer risk and should influence treatment.
        Am J Surg. 2018; 215: 819-823
        • Cibas E.S.
        • Ali S.Z.
        The 2017 Bethesda system for reporting thyroid cytopathology.
        Thyroid. 2017;
        • Whitlock M.C.
        • Schluter D.
        The Analysis of Biological Data.
        second ed. W.H. Freeman and Company, New York2015
        • Singaporewalla R.M.
        • Hwee J.
        • Lang T.U.
        • Desai V.
        Clinico-pathological correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications.
        World J Surg. 2017;
        • Tan H.
        • Li Z.
        • Li N.
        • et al.
        Thyroid imaging reporting and data system combined with Bethesda classification in qualitative thyroid nodule diagnosis.
        Med (United States). 2019;
        • Ferris R.L.
        • Baloch Z.
        • Bernet V.
        • et al.
        American thyroid association statement on surgical application of molecular profiling for thyroid nodules: current impact on perioperative decision making.
        Thyroid. 2015; 25: 760-768
        • Houlton J.J.
        • Sun G.H.
        • Fernandez N.
        • Zhai Q.J.
        • Lucas F.
        • Steward D.L.
        Thyroid fine-needle Aspiration<subtitle>Does case volume Affect diagnostic yield and interpretation?</subtitle&gt.
        Arch Otolaryngol Neck Surg. 2011; 137: 1136