Articles Vol. 67 No. 10 04/11/2026

DIAGNOSTIC VALUE OF SELECTED ULTRASONOGRAPHIC FEATURES FOR THYROID CANCER IN HIGH-RISK THYROID NODULES ACCORDING TO ACR TI-RADS.

Lam Nguyen Nha Truc, Tran Quang Phuc, Nguyen Van Ba
DOI: 10.52163/yhc.v67i10.6983
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Abstract

Objective: To evaluate the diagnostic performance of selected ultrasonographic features for thyroid cancer among high-risk nodules classified using ACR TI-RADS.

Subjects and methods: An analytical cross-sectional study included 282 patients with thyroid nodules who underwent complete ACR TI-RADS ultrasound assessment and had histopathologic reference results at Cho Ray Hospital from October 1, 2024 to October 31, 2025; 217 nodules were malignant and 65 benign. Solid composition, hypoechogenicity, taller-than-wide shape, lobulated/irregular or extrathyroidal extension margins, and microcalcifications were evaluated. OR, 95% CI, Sn, Sp, PPV, NPV, LR+, LR- and Youden index were calculated.

Results: Solid or almost solid composition was present in 81.2%, hypoechogenicity in 67.4%, marked hypoechogenicity in 12.4%, taller-than-wide shape in 43.6%, lobulated/irregular margins in 46.8%, extrathyroidal extension in 31.2%, and punctate echogenic foci in 55.7%. ORs for malignancy were 4.22 for solid composition, 2.20 for hypoechogenicity, 5.24 for taller-than-wide shape, 7.49 for microcalcifications, and 233.20 for lobulated/irregular margins or extrathyroidal extension. The latter feature showed sensitivity 97.7%, specificity 84.6%, PPV 95.5%, NPV 91.7%, LR+ 6.34, LR- 0.03 and Youden index 0.823.

Conclusion: Margin abnormality/extrathyroidal extension showed the strongest overall diagnostic performance in this high-risk cohort.

Keywords
ACR TI-RADS, thyroid cancer, ultrasonography, thyroid nodule, diagnostic accuracy.
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