Comparative Study of ACR TI-RADS and ATA 2015 for Ultrasound Risk Stratification of Thyroid Nodules

Otolaryngol Head Neck Surg. 2022 Jul;167(1):35-40. doi: 10.1177/01945998211064607. Epub 2021 Dec 14.


Objective: To study the adoption rate of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scoring system over a 3-year period in a community setting and compare its performance with that of the American Thyroid Association 2015 (ATA 2015) ultrasound risk scoring system.

Study design: Case series with prospective data collection and retrospective chart review.

Setting: Large community-based practice with multiple satellite offices and a dedicated thyroid ultrasound clinic.

Methods: All patients referred to the thyroid clinic between January 2018 and December 2020 for ultrasound-guided fine-needle biopsy were assigned an ATA 2015 risk score in a prospective manner immediately prior to biopsy. ACR TI-RADS scores were recorded through retrospective chart review of the radiologist report. Performance of the 2 systems was compared with cytology as the gold standard.

Results: A total of 949 nodules underwent biopsy, of which 236 had available data for both scoring systems. There was a 33.8% increase in adoption of the ACR TI-RADS over the 3-year study period. The ATA 2015 guidelines yielded sensitivity and specificity of 81.6% and 54.5%, respectively, as opposed to 73.7% and 27.0% for the ACR TI-RADS.

Conclusion: In our community, there has been a gradual increase in adoption of the ACR TI-RADS, although the ATA 2015 risk scoring system has performed better.

Keywords: ACR TI-RADS; ATA 2015; thyroid; thyroid nodule; ultrasound.

MeSH terms

  • Humans
  • Retrospective Studies
  • Risk Assessment
  • Thyroid Nodule* / pathology
  • Ultrasonography / methods
  • United States