use of an easily applicable thyroid imaging-reporting and data system (ti-rads): our kwak ti-rads experience

Background: early detection of malignant thyroid nodules is possible using ultrasonography (us)-guided fine needle aspiration biopsy (us-fnab), which is a minimally invasive and easily applicable method. there are several guidelines based on the us findings, including the thyroid imaging-reporting and data system (ti-rads), to identify patients requiring fnab or patients with nodules suspicious of malignancy. objectives: to emphasize the importance of the easily applicable kwak ti-rads classification system. patients and methods: in this cross-sectional study, the radiological and pathological findings of 641 consecutive patients, who underwent us-fnab in our center, were retrospectively evaluated. the relationship between the cytological/histopathological results and the us findings was investigated using univariate and multivariate analyses. the results were also compared with the data in the literature. results: in the univariate analysis, us features, including the presence of a solid component, hypoechogenicity, microlobulation or irregular margins, microcalcifications, and a taller-than-wide shape, were significantly associated with malignancy (p < 0.05). however, in the multivariate analysis, only hypoechogenicity and a taller-than-wide shape significantly contributed to the diagnosis of malignancy (p < 0.05). the malignancy rates of ti-rads 3, 4a, and 4b lesions were lower in the present study compared to the literature. conclusions: the us features, including the presence of a solid component, microcalcifications, hypoechogenicity, microlobulation or irregular margins, and a taller-than-wide shape, must be evaluated during us examinations. besides, the widespread use of kwak ti-rads classification system, similar to the breast imaging-reporting and data system (bi-rads), should be encouraged to provide a common tool for clinicians and prevent unnecessary surgical procedures.