Q: What ultrasound features suggest thyroid cancer?

Suspicious ultrasound features include: very hypoechoic appearance (darker than surrounding thyroid), taller-than-wide shape (more round than oval), irregular or lobulated margins, extrathyroidal extension (growing beyond thyroid capsule), and microcalcifications (punctate echogenic foci). Multiple suspicious features increase cancer risk. Solid composition and hypoechogenicity are common but less specific. Benign features include cystic composition, spongiform appearance, and comet-tail artifacts.

Q: How accurate is TIRADS for predicting thyroid cancer?

ACR TIRADS has good diagnostic performance with sensitivity of 60-80% and specificity of 70-85% for thyroid malignancy. It effectively risk-stratifies nodules, reducing unnecessary biopsies of benign nodules while identifying most cancers. However, no scoring system is perfect. Some cancers have benign-appearing features, and many benign nodules have suspicious features. TIRADS should be combined with clinical judgment, patient risk factors, and sometimes molecular testing for optimal management.

Q: What is the difference between ACR TIRADS and other TIRADS systems?

Multiple TIRADS systems exist: ACR TIRADS (American College of Radiology) - most widely used in US, uses point-based scoring. EU-TIRADS (European) - similar approach with different point values. K-TIRADS (Korean) - emphasizes suspicious features differently. ATA (American Thyroid Association) - uses pattern-based rather than point-based classification. ACR TIRADS is standardized, validated, and most commonly used. Our calculator uses ACR TIRADS.

Q: Can TIRADS score change over time?

Yes, TIRADS score can change if nodule characteristics change on follow-up ultrasound. Nodules can develop new suspicious features (calcifications, irregular margins, increased vascularity) warranting higher classification and potential biopsy. Conversely, some nodules remain stable or develop more benign features. This is why follow-up ultrasound is recommended for TR3-TR5 nodules - to detect changes that might alter management. Any change in ultrasound features should prompt recalculation.

Q: What happens after a TIRADS assessment?

After TIRADS assessment, next steps depend on classification: TR1-TR2: No further action needed. TR3: Follow-up ultrasound in 1-2 years if ≥1.5 cm, FNA if ≥2.5 cm. TR4: Follow-up ultrasound in 1 year if ≥1.0 cm, FNA if ≥1.5 cm. TR5: FNA if ≥1.0 cm, close surveillance if smaller. If FNA is performed, cytology results (Bethesda classification) determine final management - observation, repeat FNA, molecular testing, or surgery.

Q: How accurate is this TIRADS calculator?

This calculator uses the validated ACR TIRADS scoring system published in 2017. The point assignments and classification thresholds are standardized and evidence-based. Accuracy depends on correct identification of ultrasound features by the radiologist or sonographer. The calculator provides mathematically precise scoring, but clinical application requires expertise in thyroid ultrasound interpretation. Use this calculator in conjunction with radiology reports and endocrinology consultation for management decisions.

Question 1

What is TIRADS (Thyroid Imaging Reporting and Data System)?

Accepted Answer

TIRADS is a standardized risk stratification system for thyroid nodules detected on ultrasound. The ACR (American College of Radiology) TIRADS assigns points (0-3) to five ultrasound features: composition, echogenicity, shape, margin, and echogenic foci. The total score (0-14+ points) determines the TIRADS level (TR1-TR5), which correlates with malignancy risk and guides decisions about biopsy (FNA) and follow-up imaging.

Question 2

How do you calculate ACR TIRADS score?

Accepted Answer

To calculate ACR TIRADS score, evaluate five ultrasound features and assign points: Composition (cystic/spongiform=0, mixed=1, solid=2), Echogenicity (anechoic=0, hyper/isoechoic=1, hypoechoic=2, very hypoechoic=3), Shape (wider-than-tall=0, taller-than-wide=3), Margin (smooth/ill-defined=0, lobulated=2, extrathyroidal=3), and Echogenic Foci (none=0, macro=1, peripheral=2, punctate=3). Sum the points to determine TR level: 0=TR1, 2=TR2, 3=TR3, 4-6=TR4, ≥7=TR5.

Question 3

What do the different TIRADS levels mean?

Accepted Answer

TIRADS levels indicate malignancy risk: TR1 (0 points) = Benign, <1% cancer risk, no biopsy needed. TR2 (2 points) = Not suspicious, <1.5% risk, no biopsy. TR3 (3 points) = Mildly suspicious, 5% risk, FNA if ≥2.5 cm. TR4 (4-6 points) = Moderately suspicious, 5-20% risk, FNA if ≥1.5 cm. TR5 (≥7 points) = Highly suspicious, >20% risk, FNA if ≥1.0 cm. Higher TR levels warrant more aggressive evaluation.

Question 4

When should a thyroid nodule be biopsied?

Accepted Answer

Thyroid nodule biopsy (FNA - fine needle aspiration) is recommended based on TIRADS level and nodule size: TR1-TR2: No biopsy regardless of size. TR3: Biopsy if ≥2.5 cm. TR4: Biopsy if ≥1.5 cm. TR5: Biopsy if ≥1.0 cm. Some nodules <1.0 cm with highly suspicious features or clinical concern may also warrant biopsy. The size threshold balances cancer detection with avoiding unnecessary procedures on benign nodules.

Question 5

What ultrasound features suggest thyroid cancer?

Accepted Answer

Suspicious ultrasound features include: very hypoechoic appearance (darker than surrounding thyroid), taller-than-wide shape (more round than oval), irregular or lobulated margins, extrathyroidal extension (growing beyond thyroid capsule), and microcalcifications (punctate echogenic foci). Multiple suspicious features increase cancer risk. Solid composition and hypoechogenicity are common but less specific. Benign features include cystic composition, spongiform appearance, and comet-tail artifacts.

Question 6

How accurate is TIRADS for predicting thyroid cancer?

Accepted Answer

ACR TIRADS has good diagnostic performance with sensitivity of 60-80% and specificity of 70-85% for thyroid malignancy. It effectively risk-stratifies nodules, reducing unnecessary biopsies of benign nodules while identifying most cancers. However, no scoring system is perfect. Some cancers have benign-appearing features, and many benign nodules have suspicious features. TIRADS should be combined with clinical judgment, patient risk factors, and sometimes molecular testing for optimal management.

Question 7

What is the difference between ACR TIRADS and other TIRADS systems?

Accepted Answer

Multiple TIRADS systems exist: ACR TIRADS (American College of Radiology) - most widely used in US, uses point-based scoring. EU-TIRADS (European) - similar approach with different point values. K-TIRADS (Korean) - emphasizes suspicious features differently. ATA (American Thyroid Association) - uses pattern-based rather than point-based classification. ACR TIRADS is standardized, validated, and most commonly used. Our calculator uses ACR TIRADS.

Question 8

Can TIRADS score change over time?

Accepted Answer

Yes, TIRADS score can change if nodule characteristics change on follow-up ultrasound. Nodules can develop new suspicious features (calcifications, irregular margins, increased vascularity) warranting higher classification and potential biopsy. Conversely, some nodules remain stable or develop more benign features. This is why follow-up ultrasound is recommended for TR3-TR5 nodules - to detect changes that might alter management. Any change in ultrasound features should prompt recalculation.

Question 9

What happens after a TIRADS assessment?

Accepted Answer

After TIRADS assessment, next steps depend on classification: TR1-TR2: No further action needed. TR3: Follow-up ultrasound in 1-2 years if ≥1.5 cm, FNA if ≥2.5 cm. TR4: Follow-up ultrasound in 1 year if ≥1.0 cm, FNA if ≥1.5 cm. TR5: FNA if ≥1.0 cm, close surveillance if smaller. If FNA is performed, cytology results (Bethesda classification) determine final management - observation, repeat FNA, molecular testing, or surgery.

Question 10

How accurate is this TIRADS calculator?

Accepted Answer

This calculator uses the validated ACR TIRADS scoring system published in 2017. The point assignments and classification thresholds are standardized and evidence-based. Accuracy depends on correct identification of ultrasound features by the radiologist or sonographer. The calculator provides mathematically precise scoring, but clinical application requires expertise in thyroid ultrasound interpretation. Use this calculator in conjunction with radiology reports and endocrinology consultation for management decisions.

TIRADS Calculator - ACR TIRADS Score & Thyroid Nodule Assessment

TIRADS Assessment

ACR TIRADS Classification Levels

Example: Mildly Suspicious Nodule

How ACR TIRADS Scoring Works

TIRADS Scoring System

Biopsy Criteria by TIRADS Level and Size

Sources & References

Understanding TIRADS Ultrasound Features

1. Composition (0-2 points)

2. Echogenicity (0-3 points)

3. Shape (0 or 3 points)

4. Margin (0-3 points)

5. Echogenic Foci (0-3 points)

Frequently Asked Questions

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