"Calculator: ACR TI-RADS calculator"
"composition: (choose one)"
"echogenicity: (choose one)"
"shape: (choose one) (assessed on the transverse plane)"
"margin: (choose one)"
"echogenic foci: (choose one or more)"
"ACR TI-RADS is a reporting system for thyroid nodules on ultrasound proposed by the American College of Radiology (ACR) 1."
"Calculator: ACR TI-RADS calculator"
"Scoring is determined from five categories of ultrasound findings. The higher the cumulative score, the higher the TR (TI-RADS) level and the likelihood of malignancy."
"FNA biopsy is recommended for suspicious lesions (TR3-TR5) with the above size criteria. If there are multiple nodules, the two with the highest ACR TI-RADS scores should be sampled (rather than the two largest), with the largest size being used as a tie-breaker if there are multiple nodules of the same classification."
"Interval enlargement on follow-up is significant if there is an increase of >20% and >2 mm in two dimensions or a >50% increase in volume. If the ACR TI-RADS level increases between scans, an interval scan the following year is again recommended."
"The projected risk of malignancy in the original 2017 paper 1 was based on partial analysis of 3433 nodules with cytological results. Partial analysis at the time of publication showed rates of 20% for TR5 nodules. The final analysis 4 demonstrated a stepwise increase for each point awarded by ACR TI-RADS, with each category validated. The published malignancy rates are:"
"Developments leading to ACR TI-RADS 2017"
"The previous ACR white paper from 2015 2 developed a lexicon from descriptive reports, and this has been updated by the stratified scoring system in the 2017 white paper, rather than relying on a pattern-based system. Outcomes and recommendations are supported by another ACR paper on incidental thyroid nodules 3 and data from the Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute."
"The 2015 reporting lexicon 2 included 6 stages with a number of subdivisions (not replicated in this ACR TI-RADS) with increasing risk of malignancy."
"The ACR system does not provide a grade for "normal thyroid gland", unlike other thyroid reporting systems, preserving ACR TI-RADS for lesion reporting. TR1 instead includes benign simple and/or spongiform cysts, each meeting 0 points from the criteria. Purely anechoic/cystic lesions are assigned 0 points, whereas if described as "very hypoechoic" they would be assigned 3 points, leading to a likely fruitless FNA and probable patient/physician anxiety."
"The ACR system was published in 2017, preceded by K-TIRADS (2017) and followed by EU-TIRADS (2017). Other systems, including the ATA and SRU 5, are also in regular use."
"The ACR system was published in 2017, preceded by K-TIRADS (2017) and followed by EU-TIRADS (2017). Other systems, including the ATA and SRU 5, are also in regular use."
"The ACR system was published in 2017, preceded by K-TIRADS (2017) and followed by EU-TIRADS (2017). Other systems, including the ATA and SRU 5, are also in regular use."
"The ACR system was published in 2017, preceded by K-TIRADS (2017) and followed by EU-TIRADS (2017). Other systems, including the ATA and SRU 5, are also in regular use."
"No formal revisions to ACR TI-RADS have been made at present, although one group used artificial intelligence to refine the algorithm, with maintained high sensitivity, increased specificity, and reduced FNA rates 10."
"Calculator: ACR TI-RADS calculator"
"extra-thyroidal extension: 3 points"
"Comparative studies show the ACR system has a sensitivity ranging from 75-97% and specificity ranging from 53-67%, which is either the highest sensitivity and lowest specificity amongst compared systems 6, or, to the contrary, the highest specificity 7,8. With the latter two studies, the ACR system had the greatest overall performance (measured by area under the receiver operating characteristic curve or accuracy), resulting in lower rates of unnecessary fine needle aspiration (false positive rates) 7,8."
"Comparative studies show the ACR system has a sensitivity ranging from 75-97% and specificity ranging from 53-67%, which is either the highest sensitivity and lowest specificity amongst compared systems 6, or, to the contrary, the highest specificity 7,8. With the latter two studies, the ACR system had the greatest overall performance (measured by area under the receiver operating characteristic curve or accuracy), resulting in lower rates of unnecessary fine needle aspiration (false positive rates) 7,8."
Expected headings
"Classification"
"Recommendations"
"Risk of malignancy"
"Developments leading to ACR TI-RADS 2017"
"Comparison with other classification systems"
"Revisions"
"≥1.5 cm follow-up at 1, 3 and 5 years"
"≥1.0 cm follow-up at 1, 2, 3 and 5 years"
"Frank invasion of surrounding structures is an unfavourable prognostic sign and is assigned 3 points. If minimal extrathyroidal extension is suspected without frank invasion, especially with otherwise benign features, caution and experience should be used when reporting."