Accuracy of ultrasound TIRADS classification for the differentiation between benign and malignant thyroid lesions taking Bethesda classification as gold standard

Abstract Background The TIRADS classification system is commonly used in ultrasound imaging to evaluate the risk of malignancy in thyroid nodules, but there is still debate about its accuracy. The BSRTC categorizes FNA biopsy results to determine the likelihood of malignancy in thyroid nodules, and this remains the gold standard for diagnosis. Methodology This is a cross-sectional study design conducted in the Radiology Department of Chughtai Lab Head Office in Lahore. This study assessed 154 patients with thyroid nodules. The ultrasound equipment used for the study is the Toshiba Applio 500 model, while the equipment for FNAC included topical anesthesia, 21-gauge 10 CC syringes, glass slides, cell block, and the Olympus CX23 microscope. The sampling technique employed is the consecutive sampling technique. Results Out of 154 patients, the mean age was 42.0 ± 13.6 years. Majority were female (89%) while 11% are male. The P -value of <0.0001 suggests a statistically significant association between TIRADS and Bethesda categories. The findings suggested that ultrasonography is a highly reliable and effective method for diagnosis, with a superior degree of sensitivity and specificity in addition to invasive cytology tests. Results from the ROC curve analysis showed an impressive area under the curve of 0.972. The sonographic features show significant associations with TIRADS categories ( P -value <0.0001). The association between TIRADS suspiciousness and Bethesda diagnosis is statistically significant ( P -value <0.0001). Benign nodules were most commonly classified as not suspicious (56.5%), followed by mildly suspicious (9.7%), while malignant nodules were primarily classified as highly suspicious (11.0%). Notably, no malignant nodules were categorized as benign. Conclusion Healthcare professionals may consider utilizing TIRADS as a first-line imaging method and then BETHESDA if needed to provide patients with the most accurate results and minimize unwanted interventional exposure. Combining these two scoring methods appears to yield the most precise outcomes for identifying and distinguishing benign from malignant nodules, which is critical for arriving at a definitive diagnosis in individuals with thyroid malignancies.