Diagnostic Performance and Radiocytological Correlation of ACR TI-RADS in Thyroid Nodules Using Bethesda-Reported FNAC as the Reference Standard
DOI:
https://doi.org/10.37762/jgmds.13-4.889Keywords:
Thyroid nodules, ACR TI-RADS, Bethesda system, Thyroid cancer, Ultrasonography, Diagnostic accuracy, Fine-Needle Aspiration Cytology (FNAC)Abstract
OBJECTIVES
This study aimed to evaluate the diagnostic performance and radiocytological concordance of American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories for thyroid nodules, using fine-needle aspiration cytology (FNAC) reported according to the Bethesda System as the reference standard.
METHODOLOGY
This cross-sectional study included 134 adults aged 18–80 years presenting with clinically suspected thyroid nodules to the Department of Radiology, FC Teaching Hospital, Peshawar. High-resolution ultrasound was performed with a high-frequency linear transducer, and nodules were scored for composition, echogenicity, shape, margins, and echogenic foci. Two radiologists independently reviewed ultrasound findings while blinded to cytology. Ultrasound-guided FNAC was subsequently performed and categorised by the Bethesda System. For the submitted analysis, Bethesda IV–VI constituted the cytologically high-risk reference category and ACR TI-RADS TR4–TR5 constituted a positive ultrasound test. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated.
RESULTS
Mean participant age was 44.8 ± 12.6 years, and 102 (76.1%) were female. Thirty-eight nodules (28.4%) were classified as Bethesda IV–VI. ACR TI-RADS demonstrated 89.5% sensitivity, 85.4% specificity, 70.8% positive predictive value, 95.3% negative predictive value, and 86.6% overall accuracy. Higher TI-RADS categories were significantly associated with higher-risk Bethesda cytology (p<0.001).
CONCLUSION
ACR TI-RADS showed strong diagnostic discrimination and a particularly high negative predictive value against Bethesda-reported FNAC. Structured ultrasound risk stratification may support biopsy selection and reduce avoidable procedures, although indeterminate Bethesda categories should not be interpreted as histologically proven malignancy in this clinical cohort.
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Copyright (c) 2026 Shanza Khan, Maimoona Afsar, Ashfa Ameer Khan, Wajeeha Rahman, Hasina Gohar, Asad Rehman
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