ArticleInternational journal of general medicine2026
Diagnostic Performance of the ACR TI-RADS, C-TIRADS, K-TIRADS, and EU TI-RADS Classification Systems for Thyroid Micronodules: A Multicenter Prospective Study.
Article in International journal of general medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate and contrast how effectively the ACR TI-RADS, C-TIRADS, K-TIRADS, and EU TI-RAD identify thyroid micronodules. Methods: In this prospective study, thyroid micronodules (maximum diameter ≤10 mm) confirmed by postoperative histopathology were enrolled. These nodules were assessed on ultrasound and categorized using ACR TI-RADS, C-TIRADS, K-TIRADS, and EU TI-RADS. Postoperative pathological results served as reference standard. Receiver operating characteristics (ROC) were performed to define optimal cutoff for each TI-RADS classifications in identifying papillary thyroid microcarcinoma, and the subsequent diagnostic efficiencies of the systems were compared. Results: The areas under the curve (AUCs) corresponding to ACR TI-RADS, C-TIRADS, K-TIRADS, and EU TI-RADS were 0.685, 0.691, 0.673, and 0.608, respectively. ACR TI-RADS, C-TIRADS, and K-TIRADS did not differ significantly from one another, and all three exceeded the performance of EU TI-RADS. When the Youden index reached maximum, the optimal cut-off points were >Category 4, >Category 4B, >Category 4, and >Category 4, respectively. Under these optimal thresholds, the ACR TI-RADS demonstrated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of 90.12%, 46.62%, 90.95%, 44.23%, and 83.86%; those of the C-TIRADS were 85.58%, 48.31%, 90.78%, 36.02%, and 80.21%; those of the K-TIRADS were 88.19%, 45.95%, 90.66%, 39.53%, and 82.11%; and those of the EU TI-RADS were 98.69%, 22.97%, 88.40%, 74.73%, and 87.80%. Overall, all four TI-RADS exhibited relatively high sensitivity, positive predictive value, and accuracy. However, the specificity and negative predictive value remained low. Conclusion: The ACR TI-RADS, C-TIRADS, K-TIRADS, and EU TI-RADS demonstrated relatively limited diagnostic performance for thyroid micronodules. However, all thyroid micronodules from a surgically selected cohort with a very high malignancy rate, which is not representative of real-world thyroid nodule populations. The diagnostic metrics and optimal cutoff values cannot be directly extrapolated to the general population of patients with incidentally detected subcentimeter thyroid nodules.
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