Perspectives

TIRADS classification for thyroid nodules: application in practice

Perspectives

TIRADS classification for thyroid nodules: application in practice

Elisabeth Ng, DUNCAN J. TOPLISS

Figures

© andrey_popov/ shutterstock.com.au models used for illustrative purposes only
© andrey_popov/ shutterstock.com.au models used for illustrative purposes only

Abstract

Thyroid nodules are increasingly diagnosed on ultrasound and, although most are benign, they still require appropriate assessment and follow up. The Thyroid Imaging, Reporting and Data System (TIRADS) offers structured assessment of thyroid nodules based on five sonographic features, while the Australian Modified Bethesda Criteria (AMBC) may assist with cytological assessment. Together, the TIRADS classification and the AMBC provide a validated framework for use in the approach to assessment and management of thyroid nodules.

Key Points

  • Although thyroid nodules are common and most are benign, widespread use of diagnostic imaging has led to high rates of nodule detection and an increased need for clinicians to provide appropriate management.
  • The Thyroid Imaging, Reporting and Data System (TIRADS) classification was published in 2015 by the American College of Radiology to promote standardised terminology in the ultrasound reporting of nodules and to provide evidence-based recommendations for clinician action.
  • The TIRADS classification assists in assessing the risk of cancer in thyroid nodules based on ultrasound characteristics. It is sensitive but not highly specific; although it is unlikely to miss a clinically significant malignant nodule, it is likely to result in biopsy and follow up of a high number of nodules that turn out to be benign.
  • Using the TIRADS classification to select more suspicious nodules for fine needle biopsy refines risk assessment and selection for surgery. The Australian Modified Bethesda Criteria are useful in cytological assessment and management.
  • Nodules selected for observation using ultrasound rather than biopsy should ideally be monitored at the same imaging practice to allow for comparison, preferably by the same clinician, to reduce interobserver variability.
  • Application of the TIRADS classification does not subtract from the need for clinicians to explore patient concerns, preferences, comorbidities and prognosis when deciding on the management of a thyroid nodule.