Introduction: The American College of Radiology (ACR)-Thyroid Imaging and Reporting Data System (TIRADS) is used to classify the ultrasound (USG) findings and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is used to classify the fine needle aspiration (FNAC) findings for a solitary thyroid nodule (STN).
Objective: The objective of this study is to assess the concordance between TIRADS and TBSRTC with final postoperative histopathology in cases of STN and to calculate the risk of malignancy (ROM).
Materials and methods: The prospective observational study was conducted at a tertiary care hospital in India. Patients underwent USG and FNAC before undergoing surgery. Final concordance was analyzed with histopathology examination.
Results: The study included 80 subjects. The ROM for the TIRADS categories was 25.92%, 65.21%, and 100% for TIRADS (TR)3, TR4, and TR5 nodules, respectively. The ROM for Bethesda categories was 0% for Bethesda (B) I (BI), 6.5% for BII, 47.36% for BIII, 46.67% for BIV, and 100% for BV and BVI. Concordance was calculated using the kappa index, which was 0.21 with SE = 0.08 and 95% confidence interval (CI) = 0.061–0.359. After broad categorization, the re-calculated kappa was 0.38 with SE = 0.09 (95% CI: 0.203–0.564) with the observed agreement of 64% and by chance agreement of 41.6%.
Conclusion: There is fair concordance between ACR-TIRADS and TBSRTC. Indeterminate concordant and discordant nodules mandate a closer look owing to the high ROM.
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