The American College of Radiology (ACR) score is best for differentiating between malignant thyroid nodules and benign nodules and between medullary thyroid carcinoma and papillary thyroid carcinoma, according to a new study.

It is followed ex aequo by the ACR Thyroid Imaging Report and Data System (TI-RADS) and the Kwak TI-RADS, the researchers found. The findings were published in BMC Endocrine Disorders.

To evaluate the diagnostic values of the different systems, Ziwei Zhang, MD, and Ning Lin, MD, from the Ultrasonography Department at Fujian Provincial Hospital in Fuzhou, China studied 509 patients diagnosed with medullary thyroid carcinoma, papillary thyroid carcinoma, or benign thyroid nodules.

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Most patients (264) had benign thyroid nodules. This was followed by papillary thyroid carcinoma affecting 189 patients and medullary thyroid carcinoma in 56 patients. 

Read more about the diagnosis of medullary thyroid carcinoma

The researchers analyzed the area under the curve and constructed receiver operator characteristic curves to compare the diagnostic values of the ACR score, ACR TI-RADS, and Kwak TI-RADS.

“The data depicted that the ACR score performed the best, followed ex aequo by the ACR and Kwak TI-RADS in discriminating patients with malignant nodules from benign nodules and patients with [medullary thyroid carcinoma] from [papillary thyroid carcinoma],” Zhang and Lin wrote.

TI-RADS is a system that helps improve the diagnostic effectiveness of ultrasound.

Classification systems have been investigated for the standardized evaluation of clinical ultrasound, including the Kwak TI-RADS proposed by Kwak and colleagues in 2020, the classification of thyroid diagnosis and treatment guidelines proposed by the American Thyroid Association (ATA), and the recently updated ACR TI-RADS.


Zhang Z, Lin N. Clinical diagnostic value of American College of Radiology thyroid imaging report and data system in different kinds of thyroid nodules. BMC Endocr Disord. 2022;22:145. doi:10.1186/s12902-022-01053-z