Preoperative Evaluation of Thyroid Nodules: A Prospective Study Comparing the accuracy of Ultrasound (TI-RADS) Versus the FNAC Bethesda System in Relation to the Final Postoperative Histo-pathological Diagnosis

  • Ashraf M Abdelkader General surgery department, Faculty of medicine, Benha University, EGYPT
  • Ahmed Mohamed Zidan General surgery department, Faculty of medicine, Benha University, EGYPT
  • Mohamed Tawfeek Younis General surgery department, Faculty of medicine, Benha University, EGYPT
  • Shaimaa Kamal Dawa Pathology Department, Faculty of Medicine, Benha University, EGYPT
Keywords: Thyroid nodules, TI-RADS, Bethesda system, Thyroidectomy


Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid nodules by comparing the findings of thyroid ultrasound (US) using the thyroid image reporting and data system (TI-RADS) with the results of fine needle aspiration cytology (FNAC) that were reported according to the Bethesda system for reporting thyroid Cytopathology (TBSRTC), through matching the results of both maneuvers with the final postoperative (PO) pathology reports. Methods: The study included 100 patients suffering from thyroid swelling. Patients underwent ultrasound assessment using TI-RADS and FNAC biopsy using TBSRTC and then, all patients underwent thyroidectomy operation. Specimens sent to a laboratory for histological examination. The results of TI-RADS compared with Bethesda categories, and then both results were matched with the final histology reports. Data collected and statistically analyzed. Results: the overall concordance rate between US TI-RADS and TBSRTC is 67.6%. (82% in benign cases, 70.9%, in indeterminate cases, 50% in malignant cases). The overall concordance rate of results of TI-RADS versus FNAC with the final PO pathological results for predicting malignancy were (75.4%, 81.8%) with a sensitivity of (76.9 %, 81.8%) and specificity of (91.3%, 98%), positive predictive values were (PPV) (71.4%, 90%), and negative predictive values were (NPV) (76.4%, 96%), respectively. Conclusion: TI-RADS and TBSRTC classification systems could be considered as feasible and effective diagnostic modalities for predicting malignant lesions in patients had thyroid nodules. It's important for the clinicians to implement these diagnostic tests to improve their clinical performance and surgical outcomes.


1. Vander J, Gaston E, and Dawber T: The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1968;69:537–554.
2. Tunbridge W, Evered D, Hall R, Appleton D, Brewis M, Clark F, et al: The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977;7:481–449.
3. Mandel S: A 64-year-old woman with a thyroid nodule. JAMA. 2004;292:2632–2642.
4. Tan G, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126(3):226–231.
5. Gharib Hand Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007;36(3):707–735.
6. Grant E, Tessler F, Hoang J, Langer J, Beland M, Cronan J et al: Thyroid ultrasound reporting lexicon: white paper of the ACR thyroid imaging, reporting and data system (TIRADS) committee. J Am Coll Radiol. 2015;12 (12 Pt A): 1272–1279.
7. Horvath E, Majlis S, Rossi R, Franco C, Niedmann J, Castro A, and Dominguez M: An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009; 94(5):1748–1751.
8. Kwak J, Han K, Yoon J, Moon H, Son E, Park S, et al: Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011; 260 (3): 892–899.
9. Chng C, Kurzawinski T and Beale T: Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology. Clin Endocrinol (Oxf). 2015; 83 (5): 711–716.
10. Yoon J, Lee H, Kim E, Moon H, and Kwak J: Thyroid nodules: non- diagnostic cytologic results according to thyroid imaging reporting and data system before and after application of the Bethesda system. Radiology. 2015; 276 (2): 579–587.
11. Naykky S, Juan P, Spyridoula M, Ana E, Rene R, Michael R, Ana C, et al: Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine. 2016;53:651–661.
12. Tessler F, Middleton W, Grant E, Hoang J, Berland L, Teefey S, et al: ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017; Vol.14, Iss. 5, P 587-595.
13. Cibas E and Ali S: The 2017 Bethesda System for Reporting Thyroid Cytopathology. 2017 Nov; 27(11):1341-1346.
14. Srinivas M, Amogh V, Gautam M, Prathyusha I, Vikram N, Retnam M, et al: A prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions. J Clin Imaging Sci. 2016; 6: 5.
15. Chandramohan A, Khurana A, Pushpa B, Manipadam M, Naik D, Thomas N, Abraham D and Paul M: (2016) Is TIR- ADS a practical and accurate system for use in daily clinical practice? Indian J Radiol Imaging. 2016; 26 (1): 145–152.
16. Hoang J, Langer J, Middleton W, Hammers L, Cronan J, Tessler F, Grant E, and Berland L: Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. Journal of the American College of Radiology: JACR. 2015; 12 (2): 143-50.
17. Park J, Lee H, Jang H Kim H, Hyuck J, Lee W and Kim S: A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009; 19 (11):1257–1264
18. Moifo B, Takoeto E, and Tambe J: Reliability of thyroid imaging reporting and data system (TIRADS) classification in differentiating benign from malignant thyroid nodules. Open J Radiol. 2013; 3:103–107.
19. Hossein G, Enrico P, Jeffrey R, Daniel S, Mack H, Laszlo H, et al: American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules - 2016 Update. Endocr Pract. 2016;22(5):622–639.
20. Singaporewalla R, Hwee J, Lang T, and Desai V: Clinicopathological Correlation of Thyroid Nodule Ultrasound and Cytology Using the TIRADS and Bethesda Classifications. World J Surg. 2017; 41:1807–1811.
21. Grant E, Tessler F, Hoang J, Langer J, Beland M, Berland L, et al: Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. Journal of the American College of Radiology: JACR. 2015; 12 (12 Pt A): 1272-9.
22. Tollin S, Mery G, Jelveh N, Fallon E, Mikhail M, Blumenfeld W, et al: The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid. 2000;10:235–41.
23. Baloch Z, LiVolsi V, and Asa S: Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36(6):425–437.
24. Krzysztof K, Dorota D, Beata W, Marta S, Paweł D, Krzysztof S, et al: Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules. PLoS One. 2016; 11(1)
25. Coorough N, Hudak K, Jaumec JC, Buehler D, Selvaggi S, Rivas J, et al: Nondiagnostic fine-needle aspirations of the thyroid: is the risk of malignancy higher? J Surg Res. 2013;184:746–750.
Original Article