ACCURACY OF ULTRASOUND TIRADS SCORING IN DIFFERENTIATING MALIGNANT FROM BENIGN NODULES KEEPING FNAC AS GOLD STANDARD

Abstract

The objective of this study was to evaluate the diagnostic accuracy of the Thyroid Imaging Reporting and Data System (TIRADS) scoring system in differentiating between malignant and benign thyroid nodules using ultrasound, with fine-needle aspiration cytology (FNAC) serving as the gold standard. This cross-sectional validation study was conducted at the Radiology Department of the Combined Military Hospital (CMH) in Abbottabad over six months. A sample of 166 patients, aged 18 to 70 years, with thyroid nodules was selected through non-probability consecutive sampling. Each patient underwent a comprehensive ultrasound examination, with scoring based on the American College of Radiology TIRADS system, followed by ultrasound-guided FNAC. Nodules classified as TR1 and TR2 were considered benign, while those classified as TR3, TR4, and TR5 for study purposes were considered malignant. FNAC findings, interpreted according to the Bethesda System, served as the reference standard. Data analysis was performed using SPSS v25 to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Among the 166 patients, FNAC identified malignant and benign nodules in 60.8% and 39.2% of cases, respectively. The association between TIRADS categories and cytological outcomes was statistically significant (p = 0.000). TIRADS demonstrated high specificity and sensitivity in the diagnosis of malignancy. No significant associations were observed between malignancy and variables such as age, gender, smoking status, residence, nodule size, or goiter duration. TIRADS is a non-invasive, accurate risk stratification tool for thyroid nodules, showing strong correlation with FNAC outcomes. Its integration into routine practice could reduce unnecessary biopsies and enhance diagnostic accuracy.