Correlation of TIRADS and Bethesda Scoring Systems with Final Histopathology of Thyroid Nodules – An Institutional Experience


Fine needle aspiration cytology (FNAC) reduces the number of unnecessary thyroid surgeries for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate treatment. This was a observational study done on cases presenting with clinical suspicion of thyroid malignancy which underwent ultrasonography followed by FNAC of thyroid nodule. Ultrasonographic characterization of nodules was based on Thyroid Imaging Reporting and Data System (TIRADS) and cytology reporting was based on Bethesda system. All recruited patients underwent thyroidectomy. Pre-operative cytology and ultrasonography features were compared with final histopathology report. In our study, Bethesda system of cytology reporting for thyroid nodules had a better sensitivity, specificity and diagnostic accuracy than TIRADS system of ultrasound reporting. Bethesda system in FNAC had a larger area under the ROC curve (0.91) as compared to ultrasound TIRADS (0.70). Malignancy rate of TIRADS 5 nodules was 97.1% with significant p value (0.022). 100% of Bethesda VI lesions were malignant according to final histopathology report. Ultrasound TIRADS could pre-operatively predict malignancy in 63.6% of indeterminate thyroid nodules which were malignant according to post-operative histopathology. The overall concordance of ultrasound TIRADS, Bethesda system and histopathology was 69.8%. Higher TIRADS and Bethesda scoring among thyroid nodules was associated with increased risk of malignancy. US TIRADS is a good predictor of malignancy in indeterminate thyroid nodules.

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We take this opportunity to thank the faculty, fellows, post graduates and staff of the department of Head and Neck Surgery for their whole-hearted cooperation in completion of this study. We also express our gratitude to staff of the departments of Radiology and Pathology for the support they provided.


There was no funding for this research work.

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Correspondence to Sandeep Suresh.

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All procedures performed in studies were in accordance with the ethical standards of Regional Cancer Centre, Thiruvananthapuram approved by the Institutional Ethics Committee

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George, N.A., Suresh, S., Jiji, V. et al. Correlation of TIRADS and Bethesda Scoring Systems with Final Histopathology of Thyroid Nodules – An Institutional Experience. Indian J Otolaryngol Head Neck Surg (2021).

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  • Thyroid
  • Cancer
  • Ultrasonography
  • Bethesda
  • Histopathology