The new ACR TI-RADs: A step towards a risk stratified approach to thyroid FNA?

Author(s): Dr Declan Sheppard

Hospital: University Hospital Galway and National University of Ireland

Reference: RAD Magazine, 43, 510, 18-21


Thyroid nodules are very common: 4-8% of the general population have palpable nodules while 19-67% will have nodules sonographically. The vast majority of these thyroid nodules are benign with only a minority (2-12%) being malignant. The increasing use of sonography has resulted in what is often referred to as a “thyroid storm”. However, despite this imaging-induced epidemic with an increase in the incidence of thyroid cancers, often small indolent papillary carcinomas, the death rate has remained unchanged suggesting significant over-diagnosis and over-treatment.

Multiple sonographic features have been described and evaluated in the search for a method for reliably differentiating benign from malignant nodules. However, despite very extensive literature on the subject, there are unfortunately no sonographic features that are absolutely pathognomonic for benignity or malignancy. While there are some features that are sensitive, there is often significant overlap between benign and malignant nodules impacting on their specificity. The corollary is also the case with the most specific features, often occurring relatively infrequently, thereby impacting on their overall sensitivity and clinical usefulness

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