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Abstract

Background: Thyroid carcinoma is a common malignancy with the solitary thyroid nodule (STN) being a significant risk factor. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (Ti-RADS) is widely used for thyroid nodule risk stratification. It is essential that its performance against the gold standard fine needle aspiration cytology (FNAC) is evaluated further. Objective: To assess Diagnostic accuracy of ACR Ti-Rads in the diagnosis of thyroid carcinoma in solitary thyroid nodule taking FNAC as gold standard. Study Design: Cross-sectional validation study. Duration and Place of Study: The study was conducted from February 2025 to May 2025 at the Department of Diagnostic Radiology, Shifa International Hospital, Islamabad. Methodology: We enrolled 423 patients aged between 18-65 with suspicious thyroid nodules. ACR Ti-RADS ultrasound and FNAC for all of them were performed. Sensitivity, specificity, positive predictive value (PPV), the negative predictive value (NPV), and diagnostic accuracy of ACR Ti-RADS were determined. A stratified analysis by age and sex was performed as well. Results: The study found that ACR Ti-RADS demonstrated high sensitivity (87.50%) and NPV (93.60%), with moderate specificity (59.20%) and diagnostic accuracy (66.20%). The study also showed differences in diagnostic performance based on age and gender, with younger patients and males exhibiting better specificity and diagnostic accuracy. Conclusion: ACR Ti-RADS is a reliable, non-invasive diagnostic tool for the detection of thyroid carcinoma in patients with solitary thyroid nodules, especially when used in combination with FNAC.