European Radiology

, Volume 27, Issue 6, pp 2619–2628 | Cite as

Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules

  • Eleonora HorvathEmail author
  • Claudio F. Silva
  • Sergio Majlis
  • Ignacio Rodriguez
  • Velimir Skoknic
  • Alex Castro
  • Hugo Rojas
  • Juan-Pablo Niedmann
  • Arturo Madrid
  • Felipe Capdeville
  • Carolina Whittle
  • Ricardo Rossi
  • Miguel Domínguez
  • Hernán Tala
Head and Neck



To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness.


Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated.


The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3–60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4–5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9–100.0), specificity 74.35 % (95 % CI: 68.7–80.0), PPV 82.1 % (95 % CI: 78.0–86.3), NPV 99.4 % (95 % CI: 98.3–100.0), PLR 3.9 (95 % CI: 3.6–4.2) and an NLR 0.005 (95 % CI: 0.003–0.04) for malignancy.


US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk.

Key Points

TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4–5).

The recognition of benign/possibly benign patterns can avoid unnecessary procedures.

This classification and its sonographic patterns are validated using surgical specimens.


Thyroid nodule Thyroid neoplasm Ultrasound Risk classification Thyroid cancer 





Fine needle aspiration biopsy


Positive predictive value


Negative predictive value


Positive likelihood ratio


Negative likelihood ratio



The scientific guarantor of this publication is Eleonora Horvath MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Methodology: retrospective, diagnostic or prognostic study performed at one institution.

Supplementary material

330_2016_4605_MOESM1_ESM.docx (213 kb)
ESM 1 (DOCX 212 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Eleonora Horvath
    • 1
    Email author
  • Claudio F. Silva
    • 1
  • Sergio Majlis
    • 2
  • Ignacio Rodriguez
    • 3
  • Velimir Skoknic
    • 3
  • Alex Castro
    • 4
  • Hugo Rojas
    • 5
  • Juan-Pablo Niedmann
    • 1
  • Arturo Madrid
    • 5
  • Felipe Capdeville
    • 5
  • Carolina Whittle
    • 1
  • Ricardo Rossi
    • 5
  • Miguel Domínguez
    • 2
  • Hernán Tala
    • 2
  1. 1.Radiology Department, Clinica Alemana, Facultad de Medicina Clinica AlemanaUniversidad del DesarrolloSantiagoChile
  2. 2.Internal Medicine Department, Clinica Alemana, Facultad de Medicina Clinica AlemanaUniversidad del DesarrolloSantiagoChile
  3. 3.Medical School, Clinica Alemana, Facultad de Medicina Clinica AlemanaUniversidad del DesarrolloSantiagoChile
  4. 4.Pathology Department, Clinica Alemana, Facultad de Medicina Clinica AlemanaUniversidad del DesarrolloSantiagoChile
  5. 5.Surgery Department, Clinica Alemana, Facultad de Medicina Clinica AlemanaUniversidad del DesarrolloSantiagoChile

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