From the Guidelines
TI-RADS 3 thyroid nodules are moderately suspicious for malignancy and should be managed based on their size, with a risk of about 5-10%. According to the American College of Radiology (ACR) Appropriateness Criteria, ultrasound (US) provides high-resolution imaging to characterize the nodule for the risk of malignancy 1. For these nodules, the recommended management depends on size:
- Nodules measuring 1.5 cm or larger should undergo fine needle aspiration (FNA) biopsy
- Nodules between 1.0-1.4 cm should be followed with ultrasound in 1 year
- Nodules smaller than 1.0 cm generally don't require FNA or follow-up This stratified approach balances the risk of missing clinically significant cancer against avoiding unnecessary procedures for low-risk nodules. TI-RADS 3 nodules typically have some suspicious ultrasound features such as hypoechogenicity, solid composition, or irregular margins, but lack the more concerning features seen in higher-risk categories. When following these nodules, significant growth (more than 20% increase in two dimensions with a minimum increase of 2mm) or development of new suspicious features should prompt consideration for biopsy regardless of the initial size, as guided by the ACR TI-RADS and other risk stratification criteria 1.
From the Research
TI-RADS 3 Nodules
- TI-RADS 3 nodules are considered to have a moderate suspicion of malignancy 2, 3
- According to the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), nodules with a TI-RADS score of 3 should be considered for fine-needle aspiration (FNA) biopsy if they are 2.5 cm or larger in size 2
- A study published in the AJR American Journal of Roentgenology found that 7 out of 40 malignant nodules that were classified as TI-RADS 3 were 1 cm or larger in size 2
- Another study published in the European Journal of Radiology found that TI-RADS classification showed a sensitivity of 75% and a negative predictive value of 97.6% in detecting malignant thyroid nodules 4
Management of TI-RADS 3 Nodules
- The management of TI-RADS 3 nodules depends on their size and other clinical factors 2, 3
- Nodules with a TI-RADS score of 3 that are 2.5 cm or larger in size should be considered for FNA biopsy 2
- Smaller nodules with a TI-RADS score of 3 may be monitored with serial ultrasound examinations 3
- A study published in the La Radiologia Medica found that the TI-RADS system is safe and effective in recommending follow-up for nodules with low TI-RADS scores and benign characteristics 3
Diagnostic Accuracy of TI-RADS
- The diagnostic accuracy of TI-RADS in detecting malignant thyroid nodules has been evaluated in several studies 2, 3, 4
- A study published in the AJR American Journal of Roentgenology found that the ACR TI-RADS has a high diagnostic accuracy in detecting malignant thyroid nodules 2
- Another study published in the European Journal of Radiology found that TI-RADS classification showed a sensitivity of 75% and a negative predictive value of 97.6% in detecting malignant thyroid nodules 4