tirads 4 thyroid nodule treatment

Therefore, compared with randomly selecting 1 in 10 nodules for FNA, using ACR TIRADS to correctly rule out thyroid cancer in 1 additional patient would require more than 100 US scans (NNS>100) to find 25 TR1 and TR2 patients, triggering at least 40 additional FNAs and resulting in approximately 6 additional unnecessary diagnostic hemithyroidectomies at significant economic and personal costs. Depending on the constellation or number of suspicious ultrasound features, a fine-needle biopsy is . Department of Endocrinology, Christchurch Hospital. Here at the University of Florida, we are currently recruiting endocrinologists to work with us to help people with thyroid nodules. The following article describes the initial iterations proposed by individual research groups, none of which gained widespread use. Thyroid nodules are detected by ultrasonography in up to 68% of healthy patients. (2009) Thyroid : official journal of the American Thyroid Association. Findings of a large, prospective multicenter study from Egypt, published in the August 2019 issue of the European Journal . Russ G, Royer B, Bigorgne C et-al. This comes at the cost of missing as many cancers as you find, spread amongst 84% of the population, and doing 1 additional unnecessary operation (160.20.8=2.6, minus the 1.6 unnecessary operations resulting from random selection of 1 in 10 patients for FNA [25]), plus the financial costs involved. Applying ACR-TIRADS across all nodule categories did not perform well, with sensitivity and specificity between 60% and 80% and overall accuracy worse than random selection (65% vs 85%). Thyroid nodule size from 1.5 - 2.5cm: Periodic follow-up every 6 months. Diagnostic approach to and treatment of thyroid nodules. sharing sensitive information, make sure youre on a federal Because the data set prevalence of thyroid cancer was 10%, compared with the generally accepted lower real-world prevalence of 5%, one can reasonably assume that the actual cancer rate in the ACR TIRADS categories in the real world would likely be one-half that quoted from the ACR TIRADS data set, which we illustrate in the following section. Radiofrequency ablation uses a probe to access the benign nodule under ultrasound guidance, and then treats it with electrical current and heat that shrinks the nodule. The current ACR TIRADS system changed from that assessed during training, with the addition of the taller-than-wide and size criteria, which further questions the assumption that the test should perform in the real world as it did on a the initial training data set. doi: 10.1111/j.1754-9485.2009.02060.x Third, when moving on from the main study in which ACR TIRADS was developed [16] to the ACR TIRADS white paper recommendations [22], the TIRADS model changed by the addition of a fifth US characteristic (taller than wide), plus the addition of size cutoffs. Your email address will not be published. Unfortunately, the collective enthusiasm for welcoming something that appears to provide certainty has perhaps led to important flaws in the development of the models being overlooked. Please enable it to take advantage of the complete set of features! A normal finding in Finland. The cost of seeing 100 patients and only doing FNA on TR5 is at least NZ$100,000 (compared with $60,000 for seeing all patients and randomly doing FNA on 1 in 10 patients), so being at least NZ$20,000 per cancer found if the prevalence of thyroid cancer in the population is 5% [25]. 3, 4 The modified TI-RADS based on the ACR TI-RADS scoring system was sponsored by Wang et al. PMC ; Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. Whilst our findings have illustrated some of the shortcomings of ACR TIRADS guidelines, we are not able to provide the ideal alternative. -, Zhou J, Yin L, Wei X, Zhang S, Song Y, Luo B, et al. Thyroid Nodules. A study that looked at all nodules in consecutive patients (eg, perhaps FNA of every nodule>10 mm) would be required to get an accurate measure of the cancer prevalence in those nodules that might not typically get FNA. The probability of malignancy was based on an equation derived from 12 features 2. Following ACR TIRADS management guidelines would likely result in approximately one-half of the TR3 and TR4 patients getting FNAs ((0.537)+(0.323)=25, of total 60), finding up to 1 cancer, and result in 4 diagnostic hemithyroidectomies for benign nodules (250.20.8=4). Thyroid nodules could be classified into one of 10 ultrasound patterns, which had a corresponding TI-RADS category. Whilst we somewhat provocatively used random selection as a clinical comparator, we do not mean to suggest that clinicians work in this way. These publications erroneously add weight to the belief that TIRADS is a proven and superior model for the investigation of thyroid nodules. Would you like email updates of new search results? For this, we do not take in to account nodule size because size is not a factor in the ACR TIRADS guidelines for initial FNA in the TR1 and TR2 categories (where FNA is not recommended irrespective of size) or in the TR5 category (except in TR5 nodules of0.5 cm to<1.0 cm, in which case US follow-up is recommended rather than FNA). It has been retrospectively applied to thyroidectomy specimens, which is clearly not representative of the patient presenting with a thyroid nodule [34-36], and has even been used on the same data set used for TIRADS development, clearly introducing obvious bias [32, 37]. Cawood T, Mackay GR, Hunt PJ, OShea D, Skehan S, Ma Y. Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. For every 100 FNAs performed, about 30 are inconclusive, with most (eg, 20% of the original 100) remaining indeterminate after repeat FNA and requiring diagnostic hemithyroidectomy. This study aimed to assess the performance and costs of the American College of Radiology (ACR) Thyroid Image Reporting And Data System (TIRADS), by first looking for any important issues in the methodology of its development, and then illustrating the performance of TIRADS for the initial decision for or against FNA, compared with an imagined -, Fresilli D, David E, Pacini P, Del Gaudio G, Dolcetti V, Lucarelli GT, et al. In: Thyroid 26.1 (2016), pp. Advances in knowledge: The study suggests TIRADS and thyroid nodule size as sensitive predictors of malignancy. I have some serious news about my thyroid nodules today. This allows patients with a TR1 or TR2 nodule to be reassured that they have a low risk of thyroid cancer, rather than a mixture of nodules (not just TR1 or TR2) not being able to be reassured. First, 10% of FNA or histology results were excluded because of nondiagnostic findings [16]. However, in the data set, only 25% of all nodules were categorized as TR1 or TR2 and these nodules harbored only 1% of all thyroid cancers (9 of 343). FNA, fine-needle aspiration; US, ultrasound; CEUS, contrast-enhanced ultrasound; C-TIRADS, Chinese imaging reporting and data system. We then compare the diagnosis performance of C-TIRADS, CEUS, and CEUS-TIRADS by sensitivity, specificity, and accuracy. Thyroid Nodules: Causes, Symptoms & Treatment - Cleveland Clinic However, there are ethical issues with this, as well as the problem of overdiagnosis of small clinically inconsequential thyroid cancer. 4b - Suspicious nodules (10-50% risk of malignancy) Score of 2. Endocrinol. The first time Tirads 3 after cytology is benign, but you do not say how many mm and after 3 months of re-examination, it was . The prevalence of incidental thyroid cancer at autopsy is around 10% [3]. Haugen BR, Alexander EK, Bible KC, et al. The area under the curve was 0.803. Until TIRADS is subjected to a true validation study, we do not feel that a clinician can currently accurately predict what a TIRADS classification actually means, nor what the most appropriate management thereafter should be. Second, the proportion of patients in the different ACR TIRADS (TR) categories may, or may not, reflect the real-world population (Table 1). We examined the data set upon which ACR-TIRADS was developed, and applied TR1 or TR2 as a rule-out test, TR5 as a rule-in test, or applied ACR-TIRADS across all nodule categories. The low pretest probability of important thyroid cancer and the clouding effect of small clinically inconsequential thyroid cancers makes the development of an effective real-world test incredibly difficult. There are inherent problems with studies addressing the issue such as selection bias at referral centers and not all nodules having fine needle aspiration (FNA). Later arrival time, hypo-enhancement, heterogeneous enhancement, centripetal enhancement, and rapid washout were risk factors of malignancy in multivariate analysis. Perhaps surprisingly, the performance ACR-TIRADS may often be no better than random selection. However, these assumptions have intentionally been made to favor the expected performance of ACR-TIRADS, and so in real life ACR-TIRADS can be expected to perform less well than we have illustrated. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care. 8600 Rockville Pike To further enhance the performance of TIRADS, we presume that patients present with only 1 TR category of thyroid nodules. TIRADS does not perform to this high standard. Thyroid Imaging Reporting and Data System (TI-RADS): A User's Guide To find 16 TR5 nodules requires 100 people to be scanned (assuming for illustrative purposes 1 nodule per scan). Ultrasonographic scoring systems such as the Thyroid Imaging Reporting and Data System (TIRADS) are helpful in differentiating between benign and malignant thyroid nodules by offering a risk stratification model. Of note, we have not taken into account any of the benefits, costs, or harms associated with the proposed US follow-up of nodules, as recommended by ACR-TIRADS. In a cost-conscious public health system, one could argue that after selecting out those patients that clearly raise concern for a high risk of cancer (ie, from history including risk factors, examination, existing imaging) the clinician could reasonably inform an asymptomatic patient that they have a 95% chance of their nodule being benign. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. If the nodule got a score of more than 2 in the CEUS schedule, CEUS-TIRADS added 1 category. Bastin S, Bolland MJ, Croxson MS. Role of Ultrasound in the Assessment of Nodular Thyroid Disease. To develop a medical test a typical process is to generate a hypothesis from which a prototype is produced. Multivariate factors logistic analysis was performed and a CEUS diagnostic schedule was established. Become a Gold Supporter and see no third-party ads. Second, we then apply TIRADS across all 5 nodule categories to give an idea how TIRADS is likely to perform overall. 4. For the calculations, we assume an approximate size distribution where one-third of TR3 nodules are25 mm and half of TR4 nodules are15 mm. Therefore, the rates of cancer in each ACR TIRADS category in the data set where they used four US characteristics can no longer be assumed to be the case using the 5 US characteristics plus the introduction of size cutoffs. . Noticeably benign pattern (0% risk of malignancy) TI-RADS 3: Probably benign nodules (<5% risk of malignancy) TI-RADS 4: 4a - Undetermined nodules (5-10% risk of malignancy) Score of 1. Using TIRADS as a rule-out cancer test would be the finding that a nodule is TR1 or TR2 and hence has a low risk of cancer, compared with being TR3-5. doi: 10.1210/jendso/bvaa031. In addition, changes in nomenclature such as the recent classification change to noninvasive follicular thyroid neoplasm with papillary-like nuclear features would result in a lower rate of thyroid cancer if previous studies were reported using todays pathological criteria. TIRADS 5: probably malignant nodules (malignancy >80%). This causes the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months. Federal government websites often end in .gov or .mil. Using ACR-TIRADS as a rule-in test to identify a higher risk group that should have FNA is arguably a more effective application. doi: 10.1007/s12020-020-02441-y 2022 Jul;41(7):1753-1761. doi: 10.1002/jum.15858. The costs depend on the threshold for doing FNA. The NNS for ACR TIRADS is such that it is hard to justify its use for ruling out thyroid cancer (NNS>100), at least on a cost/benefit basis. These figures cannot be known for any population until a real-world validation study has been performed on that population. National Library of Medicine There are a number of additional issues that should be taken into account when examining the ACR TIRADS data set and resultant management recommendations. A minority of these nodules are cancers. Recently, the American College of Radiology (ACR) proposed a Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodules based on ultrasonographic features. Unable to process the form. Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. This paper has only examined the ACR TIRADS system, noting that other similar systems exist such as Korean TIRADS [14]and EU TIRADS [15]. All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance J Endocr Soc. The ROC curves of C-TIRADS, CEUS, and CEUS-TIRADS of 100 nodules in the validation cohort. Update of the Literature. ", the doctor would like to answer as follows: With the information you provided, you have a homophonic nucleus in the right lobe. The present study evaluated the risk of malignancy in solid nodules>1 cm using ACR TI-RADS. Such a study should also measure any unintended harm, such as financial costs and unnecessary operations, and compare this to any current or gold standard practice against which it is proposed to add value. The chance of finding a consequential thyroid cancer during follow-up is correspondingly low. ACR TIRADS has not been applied to a true validation set upon which it is intended to be used, and therefore needs to be considered with caution when applying it to the real-world situation. The risk of malignancy was derived from thyroid ultrasound (TUS) features. Yoon JH, Han K, Kim EK, Moon HJ, Kwak JY. View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, American College of Radiology: ACR TI-RADS, Korean Society of Thyroid Radiology: K-TIRADS, iodinated contrast-induced thyrotoxicosis, primary idiopathic hypothyroidism with thyroid atrophy, American Thyroid Association (ATA)guidelines, British Thyroid Association (BTA)U classification, Society of Radiologists in Ultrasound (SRU)guidelines, American College of Radiology:ACR TI-RADS, postoperative assessment after thyroid cancer surgery, ultrasound-guided fine needle aspiration of the thyroid, TIRADS (Thyroid Image Reporing and Data System), colloid type 1:anechoic with hyperechoic spots, nonvascularised, colloid type 2: mixed echogenicity with hyperechoic spots,nonexpansile, nonencapsulated, vascularized, spongiform/"grid" aspect, colloid type 3: mixed echogenicity or isoechoic with hyperechoic spots and solid portion, expansile, nonencapsulated, vascularized, simple neoplastic pattern: solid or mixed hyperechoic, isoechoic, or hypoechoic;encapsulated with a thin capsule, suspicious neoplastic pattern: hyperechoic, isoechoic, or hypoechoic;encapsulated with a thick capsule; hypervascularised; with calcifications (coarse or microcalcifications), malignant pattern A: hypoechoic, nonencapsulated with irregular margins, penetrating vessels, malignant pattern B: isoechoic or hypoechoic, nonencapsulated, hypervascularised, multiple peripheral microcalcifications, malignancy pattern C: mixed echogenicity or isoechoic without hyperechoic spots, nonencapsulated, hypervascularised, hypoechogenicity, especially marked hypoechogenicity, "white knight" pattern in the setting of thyroiditis (numerous hyperechoic round pseudonodules with no halo or central vascularizaton), nodular hyperplasia (isoechoic confluent micronodules located within the inferior and posterior portion of one or two lobes, usually avascular and seen in simple goiters), no sign of high suspicion (regular shape and borders, no microcalcifications), high stiffness with sonoelastography (if available), if >7 mm, biopsy is recommended if TI-RADS 4b and 5 or if patient has risk factors (family history of thyroid cancer or childhood neck irradiation), if >10 mm, biopsy is recommended if TI-RADS 4a or if TI-RADS 3 that has definitely grown (2 mm in two dimensions and >20% in volume). Copyright 2022 Zhu, Chen, Zhou, Ma and Huang. Anti-thyroid medications. In CEUS analysis, it reflected as equal arrival time, iso-enhancement, homogeneity, and diffuse enhancement, receiving a score of 0 in the CEUS model. Data sets with a thyroid cancer prevalence higher than 5% are likely to either include a higher proportion of small clinically inconsequential thyroid cancers or be otherwise biased and not accurately reflect the true population prevalence. -, Lee JH, Shin SW. Overdiagnosis and Screening for Thyroid Cancer in Korea. Instead, it has been applied on retrospective data sets, with cancer rates far above 5%, rather than on consecutive unselected patients presenting with a thyroid nodule [33]. A newer alternative that the doctor can use to treat benign nodules in an office setting is called radiofrequency ablation (RFA). 7. If you assume that FNA is done as per reasonable application of TIRADS recommendations (in all patients with TR5 nodules, one-half of patients with TR4 nodules and one-third of patients with TR3 nodules) and the proportion of patients in the real world have roughly similar proportion of TR nodules as the data set used, then 100 US scans would result in FNAs of about one-half of all patients scanned (of data set, 16% were TR5, 37% were TR4, and 23% were TR3, so FNA number from 100 scans=16+(0.537)+(0.323)=42). Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. The performance of any diagnostic test in this group has to be truly exceptional to outperform random selection and accurately rule in or rule out thyroid cancer in the TR3 or TR4 groups. The process of validation of CEUS-TIRADS model. Any test will struggle to outperform educated guessing to rule out clinically important thyroid cancer. 2022 Jun 7;28:e936368. The system is sometimes referred to as TI-RADS Kwak 6. Putting aside any potential methodological concerns with ACR TIRADS, it may be helpful to illustrate how TIRADS might work if one assumed that the data set used was a fair approximation to the real-world population. The implication is that US has enabled increased detection of thyroid cancers that are less clinically important [11-13]. In 2009, Park et al. It is limited by only being an illustrative example that does not take clinical factors into account such as prior radiation exposure and clinical features. The diagnostic schedule of CEUS could get better diagnostic performance than US in the differentiation of thyroid nodules. Thyroid cancer - Diagnosis and treatment - Mayo Clinic Unable to load your collection due to an error, Unable to load your delegates due to an error. Furuya-Kanamori L, Bell KJL, Clark J, Glasziou P, Doi SAR. government site. It is this proportion of patients that often go on to diagnostic hemithyroidectomies, from which approximately 20% are cancers [12, 17, 21], meaning the majority (80%) end up with ultimately unnecessary operations. The truth is, most of us arent so lucky as to be diagnosed with all forms of thyroid cancer, but we do live with the results of it. The specificity of TIRADS is high (89%) but, perhaps surprisingly, is similar to randomly selecting of 1 in 10 nodules for FNA (90%). Jin Z, Zhu Y, Lei Y, Yu X, Jiang N, Gao Y, Cao J. Med Sci Monit. Therefore, 60% of patients are in the middle groups (TR3 and TR4), where the US features are less discriminatory. Objectives: A negative result with a highly sensitive test is valuable for ruling out the disease. A 35-year-old woman with a nodule in the left-lobe of her thyroid gland. Thyroid imaging reporting and data system (TI-RADS) All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System Front Oncol. The test that really lets you see a nodule up close is a CT scan. The CEUS-TIRADS category was 4c. TIRADS can be welcomed as an objective way to classify thyroid nodules into groups of differing (but as yet unquantifiable) relative risk of thyroid cancer. . Shin JH, Baek JH, Chung J, et al. Diag (Basel) (2021) 11(8):137493. Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, Kim SH. tirads 4 thyroid nodule treatment - Investigative Signal Ultrasound classification of thyroid nodules: does size matter? The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS. Conclusions: The proportion of malignancy in Bethesda III nodules confirmed by surgery were significantly increased in proportion relative to K-TIRADS with 60.0% low suspicion, 88.2% intermediate suspicion, and 100% high suspicion nodules (p < 0.001). Endocrine (2020) 70(2):25679. To illustrate the effect of the size cutoffs we have given 2 examples, 1 where the size cutoffs are not discriminatory and the cancer rate is the same above and below the size cutoff, and the second example where the cancer risk of the nodule doubles once the size goes above the cutoff. Most nodules and swellings are not cancerous. This equates to 2-3 cancers if one assumes a thyroid cancer prevalence of 5% in the real world. Cystic or almost completely cystic 0 points. If your doctor found a hypoechoic nodule during an ultrasound, they may simply do some additional testing to make sure there's . Therefore, taking results from this data set and assuming they would apply to the real-world population raises concerns. Data Set Used for Development of ACR TIRADS [16] and Used for This Paper The possible cancer rate column is a crude, unvalidated estimate, calculated by proportionately reducing the cancer rates by 10.3%: 5% to reflect the likely difference in the cancer rate in the data set used (10.3%) and in the population presenting with a thyroid nodule (5%). So, for 100 scans, if FNA is done on all TR5 nodules, this will find one-half of the cancers and so will miss one-half of the cancers. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. Tessler FN, Middleton WD, Grant EG, et al. It would be unfair to add these clinical factors to only the TIRADS arm or only to the clinical comparator arm, and they would cancel out if added to both arms, hence they were omitted. Thyroid nodules are lumps that can develop on the thyroid gland. We found better sensitivity, PPV, and NPV with TIRADS compared with random selection (97% vs 1%, 13% vs 1%, and 99% vs 95%, respectively), whereas specificity and accuracy were worse with TIRADS compared with random selection (27% vs 90%, and 34% vs 85%, respectively (Table 2)[25]. and transmitted securely. The 2 examples provide a range of performance within which the real test performance is likely to be, with the second example likely to provide TIRADS with a more favorable test performance than in the real world. We aimed to assess the performance and costs of the American College of Radiology Thyroid Image Reporting And Data System (ACR-TIRADS). TI-RADS 1: normal thyroid gland TI-RADS 2: benign nodule TI-RADS 3: highly probable benign nodule TI-RADS 4a: low suspicion for malignancy TI-RADS 4b: high suspicion for malignancy TI-RADS 5: malignant nodule with more than two criteria of high suspicion Imaging features TI-RADS 2 category Constantly benign patterns include simple cyst We have also assumed that all nodules are at least 10 mm and so the TR5 nodule size cutoff of 5 mm does not apply. The CEUS-TIRADS category was 4a. It is interesting to see the wealth of data used to support TIRADS as being an effective and validated tool. EU-TIRADS 2 category comprises benign nodules with a risk of malignancy close to 0%, presented on sonography as pure/anechoic cysts ( Figure 1A) or entirely spongiform nodules ( Figure 1B ). This study has many limitations. Clinical Application of C-TIRADS Category and Contrast-Enhanced Ultrasound in Differential Diagnosis of Solid Thyroid Nodules Measuring 1 cm. Tirads 5 thyroid gland: is a thyroid gland with 5 or more lesions, the rate of malignancy accounts for 87.5%. The diagnosis or exclusion of thyroid cancer is hugely challenging. Risk Stratification of Thyroid Nodules Using the Thyroid Imaging The sensitivity, specificity, and accuracy of CEUS-TIRADS were 95.7%, 85.7%, and 92.1% respectively. The flow chart of the study. The sensitivity, specificity, and accuracy of CEUS were 78.7%, 87.5%, and 83.3% respectively. The TIRADS reporting algorithm is a significant advance with clearly defined objective sonographic features that are simple to apply in practice. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland. NCI Thyroid FNA State of the Science Conference, The Bethesda System for reporting thyroid cytopathology, ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee, Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size, Impact of nodule size on malignancy risk differs according to the ultrasonography pattern of thyroid nodules, TIRADS management guidelines in the investigation of thyroid nodules; an illustration of the concerns, costs and performance, Thyroid nodules with minimal cystic changes have a low risk of malignancy, [The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid], Malignancy risk stratification of thyroid nodules: comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines, Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination, Machine learning-assisted system for thyroid nodule diagnosis, Automatic thyroid nodule recognition and diagnosis in ultrasound imaging with the YOLOv2 neural network, Using artificial intelligence to revise ACR TI-RADS risk stratification of thyroid nodules: diagnostic accuracy and utility, A multicentre validation study for the EU-TIRADS using histological diagnosis as a gold standard, Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules, Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules, Diagnostic performance of practice guidelines for thyroid nodules: thyroid nodule size versus biopsy rates, Comparison of performance characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association Guidelines, Performance of five ultrasound risk stratification systems in selecting thyroid nodules for FNA.

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