Is TIRADS a practical and accurate system for use in daily clinical practice?

• Main Authors: Anuradha Chandramohan, Abhishek Khurana, B T Pushpa, Marie Therese Manipadam, Dukhabandhu Naik, Nihal Thomas, Deepak Abraham, Mazhuvanchary Jacob Paul
• Format: Article
• Language: English
• Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2016-01-01
• Series: Indian Journal of Radiology and Imaging
• Subjects: benign; malignant; thyroid imaging reporting and data system; thyroid nodules; ultrasound
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.4103/0971-3026.178367

Aim: To assess the positive predictive value (PPV) and inter-observer agreement of Thyroid Imaging Reporting and Data System (TIRADS) as described by Kwak et al. Materials and Methods: This was a prospective study wherein ultrasound was performed by two radiologists on patients with thyroid nodules >1 cm. The third radiologist interpreted archived images. Ultrasound features and TIRADS category were compared with cytology and surgical histopathology. PPV was calculated for all readers′ combined assessment. Inter-observer agreement was calculated using linear weighted kappa. Results: A total of 238 patients with 272 nodules of mean size 2.9 ± 1.7 cm were included. PPV for malignancy was 6.6%, 32%, 36%, 64%, 59%, and 91% for TIRADS 2, 3, 4a, 4b, 4c, and 5 categories, respectively. Inter-observer agreement was substantial [kappa (k) = 0.61-0.80] for assessment of nodule echogenicity, margins, calcification, and shape and good (k = 0.570, P < 0.001) for assessment of composition of the thyroid nodules. Overall agreement between observers was substantial for assigning TIRADS category [multi-rater weighted kappa coefficient (wt k) = 0.721, P < 0.001]. Conclusions: TIRADS is a simple and practical method of assessing thyroid nodules with high PPV and good inter-observer agreement.