Chulalongkorn Medical Journal




Ultrasound is generally considered to evaluate thyroid nodule sonographic morphology. The ultrasound-based risk stratification systems have been used to assess the probability of cancer in thyroid nodules.


To determine the efficacy of ultrasound-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) in estimating the risk of malignancy in thyroid nodules.


A descriptive retrospective cross-sectional study was conducted in Taksin Hospital. In total, 324 patients with thyroid nodules underwent sonography and surgery, which pathological diagnosis were available, from January 2008 to April 2022. The ACR-TIRADS and ultrasound features were used to determine the risk of malignancy of thyroid nodules by using surgical histologic pathology from tissue as the gold standard.


Of the 324 cases, 276 females (85.2%) and 48 males (14.8%) were eligible for inclusion. The risk of malignancy in thyroid nodules according to ACR-TIRADS had sensitivity of 94.8%, specificity of 79.3%, positive predictive value (PPV) of 50.0%, negative predictive value (NPV) of 98.6%, and accuracy of 82.1%. The ultrasound findings with high malignancy risks were extra-thyroidal extension, lobulated or irregular margin, taller-than-wide shape, very hypoechoic, punctate echogenic foci and enlarged cervical lymph nodes.


The ultrasound scoring-based ACR-TIRADS is a good indicator for evaluating cancer risk of thyroid nodules, determining further management, and reducing unnecessary thyroid biopsies.



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