Comparison of the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy with three international guidelines
Eun Ju Ha1 , Jung Hee Shin1 , Dong Gyu Na2 , So Lyung Jung3 , Young Hen Lee4 , Wooyul Paik2 , Min Ji Hong5 , Yeo Koon Kim6 , Chang Yoon Lee7
1Department of Radiology, Ajou University School of Medicine, seoul, Korea
2Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, , Gangwon-do, Korea
3Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
4Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
5Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
6Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
7Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
Corresponding Author: Jung Hee Shin ,Tel: +82-2-3410-2548, Fax: +82-2-3410-0049, Email:
Received: March 9, 2021;  Accepted: April 5, 2021.  Published online: April 5, 2021.
This study was performed to compare the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines.
From June to September 2015, 5,708 thyroid nodules (≥ 1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) from 26 institutions were evaluated. US features of the thyroid nodules were retrospectively reviewed and classified according to the categories defined by each set of guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines.
Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest in the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (> 2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤ 2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%).
The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rates for small nodules (1.0–2.0 cm), while maintaining high sensitivity for detecting malignancies > 2.0 cm.
Keywords: Fine-needle aspiration; Thyroid cancer; Thyroid Imaging Reporting and Data System; Thyroid nodule; Ultrasonography
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