Comparison of British Thyroid Association, American College of Radiology TIRADS and artificial intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Watkins, L., O'Neill, G., Young, D. and McArthur, C. (2021) Comparison of British Thyroid Association, American College of Radiology TIRADS and artificial intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate. British Journal of Radiology, 94(1123), 20201444. (doi: 10.1259/bjr.20201444) (PMID:33989038)

Abstract

Objectives: To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary FNA rates. Methods: 218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound (US) images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for fine needle aspiration (FNA). Results: 77 (35.3%) nodules were malignant. Deeming US Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilizing BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001. Conclusion: BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering US Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McArthur, Dr Claire
• Authors: Watkins, L., O'Neill, G., Young, D., and McArthur, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: British Journal of Radiology
• Publisher: British Institute of Radiology
• ISSN: 0007-1285
• ISSN (Online): 1748-880X
• Published Online: 14 May 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in British Journal of Radiology 94(1123): 20201444
• Publisher Policy: Reproduced in accordance with the publisher copyright policy