TY - JOUR
T1 - Update on ACR TI-RADS
T2 - Successes, challenges, and future directions, from the AJR special series on radiology reporting and data systems
AU - Hoang, Jenny K.
AU - Middleton, William D.
AU - Tessler, Franklin N.
N1 - Publisher Copyright:
© American Roentgen Ray Society
PY - 2020
Y1 - 2020
N2 - The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound-based risk stratification system (RSS) for thyroid nodules that was released in 2017. Since publication, research has shown that ACR TI-RADS has a higher specificity than other RSSs and reduces the number of unnecessary biopsies of benign nodules compared with other systems by 19.9-46.5%. The risk of missing significant cancers using ACR TI-RADS is mitigated by the follow-up recommendations for nodules that do not meet criteria for biopsy. In practice, after a nodule's ultrasound features have been enumerated, the ACR TI-RADS points-based approach leads to clear management recommendations. Practices seeking to implement ACR TI-RADS must engage their radiologists in understanding how the system addresses the problems of thyroid cancer overdiagnosis and unnecessary surgeries by reducing unnecessary biopsies. This review compares ACR TI-RADS to other RSSs and explores key clinical questions faced by practices considering its implementation. We also address the challenge of reducing interobserver variability in assigning ultrasound features. Finally, we highlight emerging imaging techniques and recognize the ongoing international effort to develop a system that harmonizes multiple RSSs, including ACR TI-RADS.
AB - The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound-based risk stratification system (RSS) for thyroid nodules that was released in 2017. Since publication, research has shown that ACR TI-RADS has a higher specificity than other RSSs and reduces the number of unnecessary biopsies of benign nodules compared with other systems by 19.9-46.5%. The risk of missing significant cancers using ACR TI-RADS is mitigated by the follow-up recommendations for nodules that do not meet criteria for biopsy. In practice, after a nodule's ultrasound features have been enumerated, the ACR TI-RADS points-based approach leads to clear management recommendations. Practices seeking to implement ACR TI-RADS must engage their radiologists in understanding how the system addresses the problems of thyroid cancer overdiagnosis and unnecessary surgeries by reducing unnecessary biopsies. This review compares ACR TI-RADS to other RSSs and explores key clinical questions faced by practices considering its implementation. We also address the challenge of reducing interobserver variability in assigning ultrasound features. Finally, we highlight emerging imaging techniques and recognize the ongoing international effort to develop a system that harmonizes multiple RSSs, including ACR TI-RADS.
KW - TI-RADS
KW - Thyroid
KW - Thyroid cancer
KW - Thyroid nodule
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85102222427&partnerID=8YFLogxK
U2 - 10.2214/AJR.20.24608
DO - 10.2214/AJR.20.24608
M3 - Article
C2 - 33112199
AN - SCOPUS:85102222427
SN - 0361-803X
VL - 216
SP - 570
EP - 578
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 3
ER -