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The Diagnostic Value of ACR TI ‐ RADS Descriptive Terminology for TR4 ‐5 Nodules Stratified by Diameter

Year: 2025

Type: article

Abstract: PURPOSE: To evaluate the diagnostic accuracy of ACR TI-RADS descriptors for TR4-5 thyroid nodules across different diameters. METHODS: This retrospective study analyzed 772 pathologically confirmed TR4-5 nodules categorized into ≤ 1 cm (n = 505) and > 1 cm (n = 267) groups. Diagnostic concordance (Kappa test), risk factors (logistic regression), and discriminatory performance (AUC) of ultrasound features were compared. RESULTS: Interobserver agreement was significantly higher in the > 1 cm group (Kappa = 0.432 ± 0.048 vs. 0.225 ± 0.076, p < 0.05). For ≤ 1 cm nodules, irregular margins (OR = 3.22), taller-than-wide shape (OR = 2.58), and punctate echogenic foci (OR = 2.35) were key predictors; for > 1 cm nodules, extrathyroidal extension (OR = 11.13), irregular margins (OR = 10.12), and solid composition (OR = 5.28) demonstrated stronger associations. Margin characteristics achieved the highest diagnostic accuracy in both groups (AUC: 0.642 vs. 0.734). CONCLUSION: ACR TI-RADS exhibits diameter-dependent diagnostic performance, with margin analysis remaining the most reliable feature across sizes. These findings underscore the need for diameter-specific risk stratification in thyroid nodule management.

Source: Journal of Clinical Ultrasound

DOI: 10.1002/jcu.24075

Authors: Jiaji Ruan, Xiaoshuang Chen, Jingjun Su, Xiaodong Zhang, Qiyang Lou

Institutions: Xiamen University, First Affiliated Hospital of Xiamen University, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University

Language: English

Topic: Thyroid Cancer Diagnosis and Treatment

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funder: Sun Yat-sen University