Objectives: Several ultrasound (US) -based risk stratification systems (RSS) for managing thyroid nodules have been developed and introduced into clinical practice. However, there are essential differences among these systems. This study aimed to determine and compare the category-based diagnostic performance of four US-based risk stratification systems in the detection of thyroid cancer: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS.
Materials and methods: 4238 nodules with FNA biopsy taken between January 2018 and December 2021 were included in the study. Nodules were classified according to US imaging features and compared with biopsy results. The diagnostic success of the risk stratification systems was evaluated and compared.
Results: Of the 4238 nodules, 3861 (%91,1) were benign and 376 (%8,9) were malignant. Malignancy was significantly higher in hypoechoic and marked hypoechoic nodules (p=0.001), and solid nodules (p=0.002). For detection of malignancy, AUCs were 0.862, 0.850, 0.842 and 0.835 for 2017 ACR-TIRADS, EU-TIRADS, for KTA-TIRADS and 2015 ATA guidelines, respectively. EU-TIRADS showed the highest sensitivity (91%), whereas ACR-TIRADS had the highest specificity (87%). Compared to other risk stratification systems, ACR-TIRADS resulted in significantly fewer unnecessary biopsies (p = 0.009).
Conclusion: All RSSs show high diagnostic accuracy, and have their own advantages and disadvantages. While deciding which RSS should be chosen, the population, the prevalence of the disease and gender distribution should be considered.
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