Evaluating the Diagnostic Accuracy of TI-RADS in Differentiating Benign and Malignant Thyroid Nodules Using Histopathology as the Benchmark Standard

Abstract

Objective: To evaluate the diagnostic accuracy of TI-RADS in differentiating benign and malignant thyroid nodules using histopathology as the benchmark standard.

Study Design: Cross-sectional analytical study
Place and Duration of Study: This study was conducted at the Watim Medical and Dental College, Rawalpindi from July 2024 to March 2025.

Methods: This study was conducted on 195 patients with thyroid nodules who underwent ultrasound evaluation followed by fine-needle aspiration cytology (FNAC) or thyroidectomy for histopathological confirmation. Nodules were classified according to the American College of Radiology TI-RADS (TR2–TR5) based on their sonographic features. Histopathological results were considered the gold standard.

Results: Of the 195 patients, 143 (73.3%) had benign and 52 (26.7%) had malignant nodules. The malignancy rate increased progressively with higher TI-RADS categories: 0% in TR2, 5.5% in TR3, 20.3% in TR4, and 80.8% in TR5. TI-RADS showed a sensitivity of 90.3%, specificity of 84.6%, PPV of 70.2%, NPV of 95.3%, and an overall diagnostic accuracy of 86.7%.

Conclusion: It is concluded that TI-RADS is a highly effective and reliable tool for differentiating benign from malignant thyroid nodules. Its strong correlation with histopathological outcomes confirms its diagnostic value.
Routine application of TI-RADS in thyroid ultrasound practice is recommended to enhance diagnostic accuracy, standardize reporting, and minimize unnecessary invasive procedures.