European Thyroid Association TIRADS
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At the time the article was created Derek Smith had no recorded disclosures.View Derek Smith's current disclosures
At the time the article was last revised Bálint Botz had no recorded disclosures.View Bálint Botz's current disclosures
EU-TIRADS is a reporting system designed by the European Thyroid Association for ultrasound assessment of thyroid nodules and stratification of requirement for FNA and malignancy. This system was based on an established French system, with validated results 2,3.
This is a five stage system using descriptive, pattern recognition findings on ultrasound, and size measurement.
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Assessment of the following features as well as size, location and number of nodules are recommended in the reporting of EU-TIRADS:
- anechoic / spongiform (benign)
- isoechoic / hyperechoic (low risk)
- mildly hypoechoic (intermediate risk)
- markedly hypoechoic (high risk)
- non-oval (high risk)
- irregular (high risk)
- microcalcifications (high risk)
- EU-TIRADS 1: no nodule
- EU-TIRADS 2: benign
- EU-TIRADS 3: low risk (oval, smooth margin, iso / hyperechoic, no high risk features)
- EU-TIRADS 4: intermediate risk (oval, smooth margin, mildly hypoechoic, no high risk features)
- EU-TIRADS 5: any high risk features (non-oval, irregular margin, microcalcifications, marked hypoechogenicity)
- EU-TIRADS 2: no FNA required (unless for theraputic purpose / relieve compression)
- EU-TIRADS 3: >20 mm FNA
- EU-TIRADS 4: >15 mm FNA
- EU-TIRADS 5: >10 mm FNA, <10 mm consider FNA or active surveillance
Regardless of US appearance, if the nodule is hot on scintigraphy then the lesion is almost certainly benign and does not require sampling.
Risk of malignancy
- EU-TIRADS 1: n/a
- EU-TIRADS 2: 0%
- EU-TIRADS 3: low risk (2-4%)
- EU-TIRADS 4: intermediate risk (6-17%)
- EU-TIRADS 5: high risk (26-87%)
Comparison with other classification systems
The EU-TIRADS system was published in 2017, following K-TIRADS (2016) and ACR TI-RADS (2017). Other systems including the ATA and SRU are also in regular use.
A number of comparative studies of the systems 5,6 show the EU-TIRADS system has sensitivity 83-86% and specificity 32-79%. The rate of unnecessary FNA was 25%, again the intermediate of the three TIRADS.
Good interobserver agreement regarding decision to biopsy has also been shown (Cohen kappa 0.68) 7.
- 1. Gilles Russ, Steen J. Bonnema, Murat Faik Erdogan, Cosimo Durante, Rose Ngu, Laurence Leenhardt. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. (2019) European Thyroid Journal. 6 (5): 225. doi:10.1159/000478927 - Pubmed
- 2. Gilles Russ, Bénédicte Royer, Claude Bigorgne, Agnès Rouxel, Marie Bienvenu-Perrard, Laurence Leenhardt. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. (2013) European Journal of Endocrinology. 168 (5): 649. doi:10.1530/EJE-12-0936 - Pubmed
- 3. Jung Hyun Yoon, Kyunghwa Han, Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak. Diagnosis and Management of Small Thyroid Nodules: A Comparative Study with Six Guidelines for Thyroid Nodules. (2016) Radiology. 283 (2): 560-569. doi:10.1148/radiol.2016160641 - Pubmed
- 4. Ting Xu, Ya Wu, Run-Xin Wu, Yu-Zhi Zhang, Jing-Yu Gu, Xin-Hua Ye, Wei Tang, Shu-Hang Xu, Chao Liu, Xiao-Hong Wu. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination. (2019) Endocrine. 64 (2): 299. doi:10.1007/s12020-018-1817-8 - Pubmed
- 5. Ting Xu, Ya Wu, Run-Xin Wu, Yu-Zhi Zhang, Jing-Yu Gu, Xin-Hua Ye, Wei Tang, Shu-Hang Xu, Chao Liu, Xiao-Hong Wu. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination. (2019) Endocrine. 64 (2): 299. doi:10.1007/s12020-018-1817-8 - Pubmed
- 6. Grani, Giorgio, Lamartina, Livia, Ascoli, Valeria, Bosco, Daniela, Biffoni, Marco, Giacomelli, Laura, Maranghi, Marianna, Falcone, Rosa, Ramundo, Valeria, Cantisani, Vito, Filetti, Sebastiano, Durante, Cosimo. Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the “Right” TIRADS. (2019) The Journal of Clinical Endocrinology & Metabolism. 104 (1): 95. doi:10.1210/jc.2018-01674 - Pubmed
- 7. Giorgio Grani, Livia Lamartina, Vito Cantisani, Marianna Maranghi, Piernatale Lucia, Cosimo Durante. Interobserver agreement of various thyroid imaging reporting and data systems. (2018) Endocrine Connections. 7 (1): 1. doi:10.1530/EC-17-0336 - Pubmed