الفهرس 
ANATOMY AND PATHOLOGY OF THYROID GLANDOnly 14 pages are availabe for public view
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Abstract
H
igh-resolution ultrasound is considered as the most sensitive test for detecting thyroid nodules. One of most challenging issue in ultrasound is how to describe the thyroid lesion as close to final pathology feature as possible. Ultrasonography has many features that are subjectively described with no unique digital (objective) expression.
Fine needle aspiration of the nodules is gold standard, practical and almost conclusive test to determine whether the nodule is malignant or not, but because it is an invasive technique and also because most nodules are benign and even malignant nodules, particularly ones smaller than 1 cm, frequently exhibit indolent or non-aggressive behavior. Therefore, not all detected nodules require FNA and/or surgery, so a comprehensive and structural reporting system was required for better nodule assessment and better radiologists-clinicians communication.
The Thyroid Imaging Reporting and Data System (TIRADS) presented by Horvath et al. in 2009 for standardization of ultrasound imaging was the first to adopt this approach to the interpretation of US images and the detection of thyroid malignancies. They took as an example the well-known concept of BI-RADS (Breast Imaging Reporting and Data System) mammographic scale, which is successfully adopted worldwide. The main purpose of the system was to develop a unified language with terms for interpreting thyroid images to create recommendations for further action.
In recent years many societies and associations suggested different TIRADS classifications based on ultrasound features of nodules providing risk stratification of each category with different sensitivity and specificity of each classification.
One of these classifications is one developed by the American college of radiology (ACR TIRADS) the uses score-based system for classification of the nodule and hence risk stratification of each category TR1 benign, TR2 non-suspicious, TR3 mildly suspicious, TR4 moderately suspicious and TR5 high suspicious, with recommendation for FNA or follow-up for each category according to its size.
In this study we used ACR TIRADS system for risk stratification of our cases with results close to that published in recent few years.
CONCLUSION & RECOMMENDATION
• TIRADS like BIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy.
• ACR TIRADS a new classification system for predicting the possibility of nodules malignancy. It may leads to a significant decline of the cases that undergo unnecessary fine needle aspiration cytology.
• Feature analysis with pattern bases approach help in stratifying benign, suspicious and malignant lesions.
• We recommend further multi-centers prospective studies in the same issue for more evidence-based results and to reach to a classification system for the thyroid gland nodule that will be easy to use, reliable, and reproducible to make easier communication between all clinical specialties.
• Also future prospective longitudinal studies that take into consideration the outcomes and financial burden should help guide revisions of all systems and hopefully may guide to one widely-accepted unified multidisciplinary TIRADS system.