Korean J Radiol.  2016 Oct;17(5):811-821. 10.3348/kjr.2016.17.5.811.

A Multicenter Prospective Validation Study for the Korean Thyroid Imaging Reporting and Data System in Patients with Thyroid Nodules

  • 1Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea.
  • 2Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea. mdmoonwj@naver.com
  • 3Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.
  • 4Department of Radiology, Ansan Hospital, Korea University School of Medicine, Ansan 15355, Korea.
  • 5Department of Radiology, New Korea Hospital, Gimpo 10086, Korea.
  • 6Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea.


To validate a new risk stratification system for thyroid nodules, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), using a prospective design.
From June 2013 to May 2015, 902 thyroid nodules were enrolled from four institutions. The type and predictive value of ultrasonography (US) predictors were analyzed according to the combination of the solidity and echogenicity of nodules; in addition, we determined malignancy risk and diagnostic performance for each category of K-TIRADS, and compared the efficacy of fine-needle aspiration (FNA) with a three-tier risk categorization system published in 2011.
The malignancy risk was significantly higher in solid hypoechoic nodules, as compared to partially cystic or isohyperechoic nodules (each p < 0.001). The presence of any suspicious US features had a significantly higher malignancy risk (73.4%) in solid hypoechoic nodules than in partially cystic or isohyperechoic nodules (4.3-38.5%; p < 0.001). The calculated malignancy risk in K-TIRADS categories 5, 4, 3, and 2 nodules were 73.4, 19.0, 3.5, and 0.0%, respectively; and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy were 95.5, 58.6, 44.5, 96.9, and 69.5%, respectively, in K-TIRADS categories 4 and 5. The efficacy of FNA for detecting malignancy based on K-TIRADS was increased from 18.6% (101/544) to 22.5% (101/449), as compared with the three-tier risk categorization system (p < 0.001).
The proposed new risk stratification system based on solidity and echogenicity was useful for risk stratification of thyroid nodules and the decision for FNA. The malignancy risk of K-TIRADS was in agreement with the findings of a previous retrospective study.


Thyroid nodules; Thyroid cancer; Thyroid imaging reporting and data system; Ultrasonography; Fine needle aspiration; Risk stratification; Thyroid neoplasm; Malignancy risk; Core needle biopsy

MeSH Terms

Biopsy, Fine-Needle/methods
Diagnosis, Differential
Middle Aged
Predictive Value of Tests
Prospective Studies
Research Design
Retrospective Studies
Risk Assessment/methods
Sensitivity and Specificity
Thyroid Neoplasms/diagnostic imaging/pathology
Thyroid Nodule/*diagnostic imaging/pathology


  • Fig. 1 Flow chart of study group. CNB = core needle biopsy, FNA = fine needle aspiration, US = ultrasonography

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