Evaluation of concordance between the Bethesda System for Reporting Thyroid Cytopathology 2023 (TBSRTC) and ACR-TIRADS at a tertiary care center in Gujarat.

BACKGROUND

Recent advancements in diagnostic techniques have resulted in a higher detection rate of thyroid cancers within existing thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) 2023 and the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) are first-line investigations for thyroid nodules, aiding in diagnosis and management decisions.

OBJECTIVES

To evaluate the concordance between TBSRTC 2023 and ACR-TIRADS in reporting thyroid lesions and assess their accuracy in diagnosing malignancies.

MATERIALS AND METHODS

This retrospective, laboratory data-based study included patients presenting with thyroid nodules, who underwent ultrasonography and fine needle aspiration cytology (FNAC), followed by thyroidectomy. Overall concordance between TBSRTC, ACR-TIRADS, and histopathologic diagnosis was evaluated, along with their diagnostic accuracy. Risk of malignancy (ROM) was calculated for both systems using the final HPE diagnosis.

RESULTS

115 patient records were analyzed. Interobserver agreement between TBSRTC and ACR-TIRADS was moderate (kappa = 0.493 ± 0.093 [±SE]). ROM across extremes of TBSRTC and TIRADS categories were found to be similar. Higher TBSRTC grades correlated with higher ACR-TIRADS grades (Spearman's rank correlation coefficient = 0.594, P = 4.5 × 10 -16). The accuracy of FNAC findings and TIRADS to predict malignancy was 84.35% versus 80.87%, with no statistically significant difference (P = 0.644).

CONCLUSION

Our findings suggest a good concordance between both reporting systems for thyroid nodules, with moderate interrater agreement. Both systems are equally useful for surgical decision-making and avoiding unnecessary surgeries.