Diagnostic capabilities of a malignancy risk stratification system in ultrasound examination of focal thyroid lesions

   Background. The high prevalence of thyroid nodules (up to 68% with high-resolution ultrasound) combined with a low malignancy rate (5–6.5 %) creates a risk of overdiagnosis and unnecessary invasive interventions. Risk stratification systems such as TI-RADS are intended to standardize ultrasound assessment; however, their performance in different morphological groups remains insufficiently studied.

   Objective. To evaluate the diagnostic significance of the TI-RADS system in ultrasound examination of focal thyroid pathology with histological verification.

   Materials and methods. A retrospective analysis of ultrasound reports of 284 patients (aged 18–83 years) with a morphologically confirmed diagnosis (based on fine-needle aspiration biopsy or postoperative histology) was performed. Patients were divided into three groups: benign non-neoplastic diseases (n = 141), adenomas (n = 52), and thyroid cancer (n = 91). Ultrasound was performed using a multiparametric protocol (B-mode, color and power Doppler imaging). Each nodule was assigned a TI-RADS category. Statistical analysis included calculation of sensitivity, specificity, and ROC analysis.

   Results. The proportion of nodules classified as TI-RADS 2 was 23.1 %, TI-RADS 3 – 11.2 %, TI-RADS 4 – 25.6 %, and TI-RADS 5 – 40.1 %. Sensitivity and specificity of TI-RADS for detecting thyroid cancer were 91.04 % and 91.41 %, respectively (AUC = 0.963). For adenomas, sensitivity decreased to 61.6 % and specificity to 82.4 %.

   Conclusion. The TI-RADS system has high predictive ability in the diagnosis of thyroid cancer, but its effectiveness in differentiating adenomas is limited, which calls for an individualized approach.

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