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Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

Katarzyna Dobruch-Sobczak*1, Zbigniew Adamczewski*2, Marek Dedecjus3, Andrzej Lewiński4,5, Bartosz Migda*6, Marek Ruchała7, Anna Skowrońska-Szcześniak*8, Ewelina Szczepanek-Parulska*7, Klaudia Zajkowska*3, Agnieszka Żyłka*3

Affiliation and address for correspondence
J Ultrason 2022; 22: e121–e129
DOI: 10.15557/JoU.2022.0020
Abstract

Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

Keywords
thyroid; ultrasound classifications; EU-TIRADS; ACR-TIRADS; K-TIRADS; FNAB