Integrated ACR TI-RADS and Bethesda Classification Improves Thyroid Nodule Malignancy Risk Stratification

In 80 patients with thyroid nodules, combined ACR TI-RADS and Bethesda classification: concordant high-risk designations were uniformly malignant. TI-RADS sensitivity 77.8%, specificity 90.3%, AUC 0.91; Bethesda NPV 95.4%.

• Overall cyto-radiological concordance was 85% (κ=0.42, moderate agreement).
• Risk of malignancy rose from 0% in TR1-TR2 to 50% in TR5; Bethesda (OR 3.8) and TI-RADS (OR 2.6) independently predicted malignancy.

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