Diagnostic accuracy of ACR TI-RADS combined with puncture feeling in differentiating benign and malignant thyroid nodules: A prospective observational study
Shadab Maqsood, Inzamam Wani, Nazia M Walvir, Zubaida Rasool, Abdul H Wani, Mudasir H Bhat, Tahleel A Shera, Aamir M ShahABSTRACT
Background:
Thyroid nodules are commonly detected on ultrasonography and can be differentiated into benign or malignant lesions using the ACR TI-RADS (American College of Radiology—Thyroid Imaging Reporting and Data System) classification. Fine-needle aspiration cytology (FNAC) is widely used for evaluating malignancy. Recent studies suggest that puncture feeling during FNAC may also help predict malignancy.
Objectives:
The primary objective of this study was to evaluate the diagnostic performance of ACR TI-RADS combined with puncture feeling during FNAC for diagnosing malignant thyroid nodules. The secondary objective was to categorize these lesions based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), 2023 edition.
Materials and Methods:
This single-center prospective observational study included 201 consecutive patients with thyroid nodules. All patients underwent ultrasonography according to ACR TI-RADS classification, followed by FNAC, during which an experienced radiologist assessed the puncture feeling. Final cytopathological diagnosis was established according to TBSRTC 2023.
Results:
Among 201 thyroid nodules, 100 (49.75%) were categorized as malignant. ACR TI-RADS demonstrated a sensitivity of 86% and specificity of 84.16% for diagnosing malignant thyroid nodules. Puncture feeling demonstrated a sensitivity of 77% and specificity of 86.14%. Combining both methods resulted in a sensitivity of 74% and a specificity of 86.14%.
Conclusion:
ACR TI-RADS demonstrated good diagnostic performance, while puncture feeling showed good specificity for predicting malignancy. Although combining both methods did not substantially improve overall diagnostic accuracy, puncture feeling may serve as a simple complementing parameter during routine FNAC evaluation, particularly in cases with inconclusive cytopathological findings.